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Archived: Polmedics Limited - Wellingborough

Inspection Summary


Overall summary & rating

Updated 18 April 2017

We carried out an unannounced focused inspection on 10 February 2017 of Polmedics Limited - Wellingborough. We carried out this inspection because the provider confirmed to the Commission that this location re-commenced the provision of dental services only to patients as from 7 February 2017 following previous actions taken by the provider to voluntarily suspend all services on 19 December 2016 provided across all Polmedics Ltd locations until 31 January 2017 including Polmedics Limited – Wellingbrough. The provider had taken this course of action following serious concerns raised following a series of inspections carried out at Polmedics Limited - Allison Street, Birmingham on 9 & 30 November 2016, Polmedics Limited - West Bromwich on 16 December 2016 and Polmedics Limited - Rugby on 17 December 2016 identifying serious concerns linked to the provider’s lack of governance and infrastructure arrangements.

This inspection was carried out at the same time as an announced inspection of Polmedics Ltd (the provider) at their administrative head office located at 36 Regent Place, Rugby CV21 2PN to assess their governance, infrastructure and leadership arrangements. During the inspection which had taken place at the administrative head office, we were informed by the provider that Polmedics Limited – Wellingborough was closed to patients on 10 February 2017. However, we found evidence that this location was open to patients from midday and patient appointments had been pre-booked for the day of our inspection. We therefore commenced our inspection from midday

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

Background

Polmedics Limited – Wellingborough is an independent provider of dental and gynaecology services. The practice is located within the town centre of Wellingborough, Northamptonshire. Services are provided primarily to polish patients who reside in the United Kingdom (UK). Services are available to people on a pre-bookable appointment basis. At the time of our inspection, the provider had voluntarily suspended all services with the exception of dentistry as a result of concerns found during previous inspections carried out by the Commission at three other locations during November and December 2016.

This inspection focused solely upon the dental services provided by the clinic. On the day that we visited we found these were the only services being offered.

The practice is situated in a converted Victorian property. On the ground floor there is a waiting room with a reception area, the main dental treatment room and a decontamination room. In the basement there is a staff room, and storage areas. On the first floor of the property are the second dental treatment room as well as a consulting room and a gynaecology treatment room. Toilets for staff and patients are located on the first floor.

The practice is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; family planning, maternity and midwifery services and surgical procedures.

The practice holds a list of registered patients and offers services to patients who reside in Wellingborough and surrounding areas but also to patients who live in other areas of the UK who require their services. The provider provides regulated activities from seven different locations. We were informed by the provider that there are approximately 33,000 registered patients across all Polmedics Ltd locations.

The practice does not currently have a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

The provider is not required to offer an out of hours service. Patients who need emergency medical assistance out of corporate operating hours are requested to seek assistance from alternative services such as the NHS 111 telephone service or accident and emergency.

Our key findings were:

  • The practice had limited formal governance arrangements in place. Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement. For example, there was no evidence of an x-ray audit being completed.
  • Arrangements to safeguard children and vulnerable adults from abuse did not reflect relevant legislation and local requirements. The practice manager was unaware who the lead was at the practice.
  • The dentist had been told in December 2016 not to take any x-rays until training was completed. However, we saw in patient records that x-rays had been taken in December 2016 and on 4 February 2017. We spoke with the practice manager who confirmed that the dentist should not be taking x-rays at present.
  • Not all risks to patients were assessed and well managed. The practice was using easy cleaning solution for metal and jewellery in the ultrasonic cleaner. There were no soil tests completed and there was no lid for the ultrasonic cleaner. Instruments were found in autoclave from the previous day that had not been processed.

  • The provider had not ensured that a registered manager was in place. It is a requirement of registration with the Care Quality Commission where regulated activities are provided to have a registered manager in place. The person that was named as the registered manager was no longer at this practice.

  • The practice did not have an effective, overarching governance framework in place to support the delivery of the strategy and good quality care. There was a lack of effective systems and processes in place for assessing and monitoring risks and the quality of the service provision.

  • The practice was only allowing patients to pay in cash for services at the time of our inspection.

  • The practice had a number of policies and procedures in place to govern activity, but some of these required updating and some policies were not reflective of current practice.

  • Information about how to complain was available and easy to understand however, the practice manager did not know who was responsible for dealing with complaints in the practice or at the head office.

  • There was no system in place to ensure that an accurate, complete and contemporaneous record was maintained for every patient.

We identified regulations that were not being met and the provider must:

  • Ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice and the General Dental Council regarding clinical examinations and record keeping.
  • Ensure audits of radiography are undertaken at regular intervals to help improve the quality of service.
  • Ensure effective systems and processes are in place for identifying, assessing and monitoring risks and the quality of the service provision.
  • Ensure arrangements to safeguard children and vulnerable adults from abuse reflect relevant legislation and local requirements.
  • Ensure effective processes for timely reporting, recording, acting on and monitoring of significant events, incidents and near misses are in place.
  • Review complaints processes to ensure staff and patients understand the complaints system.
  • Ensure there is effective clinical leadership in place and a system of clinical supervision/mentorship for all clinical staff including trainee dental nurses.
  • Ensure that patient safety alerts such as those issued by the Medicines and Healthcare Regulatory Authority (MHRA are received by the practice, and then actioned if relevant. Put systems in place to ensure all doctors are kept up to date with national guidance and guidelines.

  • Ensure that there are appropriate systems in place to properly assess and mitigate against risks including risks associated with infection prevention and control, decontamination of dental equipment, and legionella. Review procedures to ensure compliance with the practice annual statement in relation to infection prevention control required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

There were areas where the provider could make improvements and should:

  • Review processes for ensuring fees are explained to patients prior to the procedure to enable patients to make informed decisions about their care.

  • Ensure a system of appraisals is in place to ensure all members of staff receive an appraisal at least annually.
  • Ensure appropriate policies and procedures are implemented, relevant to the practice ensuring all staff are aware of and understand them.
Inspection areas

Safe

No action required

Updated 19 April 2016

We found that this practice was providing safe care in accordance with the relevant regulations.

The practice had in place medicines to be used in the event of a medical emergency in line with the recommendations of the British National Formulary.

The practice had measures in place to safeguard children and vulnerable adults. Contact numbers to raise a concern were readily available on the premises, and staff we spoke with had a good understanding of how and when to raise a concern.

One X-ray machine on the premises had been recently tested, and was working within safe parameters; however there was no evidence that either X-ray machine had been serviced in accordance with the manufacturers’ instructions.

Effective

No action required

Updated 19 April 2016

We found that this practice was providing effective care in accordance with the relevant regulations.

The practice used a comprehensive medical history form which asked questions in both Polish and English, and medical history was checked verbally at each appointment.

The dentists we spoke with had limited or no understanding of the national guidelines available to aid clinical practice such as the National Institute for Health and Care Excellence and the Faculty of General Dental Practitioners.

Staff were supported to undertake training, and the practice had subscribed to an online training programme so that staff were able to undertake training at a time that suited them.

Dental care records we were shown lacked detail, did not always note the presenting complaint or the options for treatment, although dentists said patients were given options, but this was not always recorded.

Caring

No action required

Updated 19 April 2016

We found that this practice was providing caring services in accordance with the relevant regulations.

We observed staff welcoming patients to the practice and dealing with their concerns in a kind and friendly manner.

Staff were aware of the importance of confidentiality, and were able to demonstrate how patients’ details were kept private, and describe how they could have a private discussion with a patient away from the waiting area.

Responsive

No action required

Updated 19 April 2016

We found that this practice was providing responsive care in accordance with the relevant regulations.

The practice was equipped to carry out the dental services that it offered, and we saw evidence that ample time was allowed through the scheduling of appointments to allow for discussion of diagnosis and treatment.

The practice was open from 10am to 8pm Monday to Saturday, and from 10am to 6pm on a Sunday providing opportunities for patients to attend at a time that suited them.

The practice welcomed patients from all backgrounds and cultures, and was able to provide a translator for English speakers to see the Polish speaking clinicians.

Well-led

No action required

Updated 14 November 2016

We found that this practice was providing well-led care in accordance with the relevant regulations.

The practice had made changes to the governance arrangements and taken steps to ensure that all dentists were aware of current national guidance in the care and treatment of patients.

Changes had been made to the testing schedule of the ultrasonic cleaner, although the time between testing was variable. The practice manager assured us that this would be rectified immediately.

The practice were using clinical audit to assess and improve the quality of clinical care received by the patients. Audits in infection control, X-rays and record keeping were completed since our initial inspection.