Updated 3 November 2021
We undertook a follow-up focused inspection of The Crescent Dental Practice. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements following our visit to the practice on 7 July 2021.
The inspection was led by a CQC inspector who was supported by a specialist dental adviser.
We undertook a comprehensive inspection of The Crescent Dental Practice on 8 June 2021 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing safe, effective or well- led care and was in breach of regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In response to our findings, we took urgent enforcement action, closing the practice for a period of 28 days during which the provider was required to make improvements. We revisited the practice on 7 July 2021 to check on improvements made. We found that sufficient improvements had been made to allow the practice to open again from Monday 12 July 2021. There were some areas that required further improvement and we set these out in our report from that inspection, published on 27 July 2021.
You can read our reports of these inspections by selecting the 'all reports' link for The Crescent Dental Practice on our website www.cqc.org.uk.
As part of this inspection we asked:
• Is it well-led?
When one or more of the five questions are not met, we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.
Our findings were:
Are services well-led?
We found this practice was providing well-led care in accordance with the relevant regulations.
The provider had made improvements in relation to the regulatory breach we found at our inspection on 7 July 2021.
Background
The Crescent Dental Practice is in the West Derby area of Liverpool and provides largely NHS treatment for adults and children. Some private treatment is available.
There is level access to the practice for people who use wheelchairs and those with pushchairs. There is some car parking available outside the practice.
The dental team includes seven dentists, four qualified dental nurses, six trainee dental nurses, one dental hygiene therapist, a practice administrator and a practice manager. The practice has five treatment rooms.
The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.
During the inspection we spoke with the practice owner, two dental nurses, staff working in reception, the practice administrator and the practice manager.
The practice is open from Monday to Friday 9.30am to 5.30pm.
Our key findings were:
- Staff were following recommended guidance in respect of Infection prevention and control. Processes and procedures had been introduced to uphold standards of infection control and staff had received training on the related
‘Health Technical Memorandum 01-05 (HTM01-05) Decontamination in primary dental care services’. Validation checks on equipment used to clean dental instruments were being undertaken as required and records of this were in place.
- Our observation of dental nurses working in the decontamination room indicated that further training was required on the provision of HTM01-05.
- Needlestick injury posters were in place around the practice. These had the contact details of local occupational health services, for use in the event of injury.
- Emergency medicines and equipment, (including the recommended volume of medical oxygen) were available as described in recognised guidance. Daily checks on all medical emergency equipment and medicines were in place and we found these to be effective.
- The complaint handling policy and procedure had been updated to reflect recognised guidance on handling complaints and concerns in the NHS.
- A system was in place to provide oversight of staff training and continuing professional development (CPD).
- All required recruitment checks were in place for staff. One of the staff background checks required further follow-up.
- The required check on staff levels of immunity to blood borne diseases, for example, Hepatitis B, had been carried out and records of these held. Further follow-up was required for one staff member.
- The provider had adapted the appointment booking system in order to effectively support safe flow of patients through the practice in a way that upheld COVID security. Our review of dental care and treatment records showed that not all clinicians were recording their observance of required fallow times between patient treatments.
There were areas where the provider could make improvements. They should:
- Take action to ensure the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular that the decontamination room is developed and improved to meet the requirements of the size of the practice.
- Take action to ensure audits, for example of dental treatment records and infection prevention and control are undertaken at regular intervals to improve the quality of the service. The provider should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
- Take action to ensure the practice stores records relating to people employed and the management of regulated activities in compliance with legislation and take into account current guidance. Particularly, that where staff have failed to supply required evidence of checks, that these are followed up.