We carried out an unannounced comprehensive inspection on 14 July 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?
Our findings were:
Are services safe?
We found that this practice was not providing safe care in accordance with the relevant regulations.
Are services effective?
We found that this practice was not providing effective care in accordance with the relevant regulations.
Are services caring?
We found that this practice was not providing caring services in accordance with the relevant regulations.
Are services responsive?
We found that this practice was providing responsive care in accordance with the relevant regulations.
Are services well-led?
We found that this practice was not providing well-led care in accordance with the relevant regulations.
Background
Addiscombe Dental Surgery is located in the London Borough of Croydon. The premises consist of two treatment rooms. One of the surgeries is located on the ground level and the other surgery is on the upper level where stairs from the reception led to the room. There is no separate decontamination room. The upper level surgery has a decontamination area. There are two separate toilet facilities for staff and patients, two waiting areas, a small reception area, and an administrative office on the third level. Stairs from the reception level led to a basement level where there were two store rooms.
The practice provides NHS and private dental services and treats both adults and children. The practice offers a range of dental services including routine examinations, treatment and oral hygiene.
The practice staffing consisted of one dentist (who was the owner and manager), two trainee dental nurses and one part-time hygienist. One trainee dental nurse works on reception and the other with the dentist or hygienist.
The practice is open Monday 9:00am to 2:00pm, Tuesday and Thursday 9:00am to 5:30pm and Friday 8:00am to 2:00pm. The hygienist works on Tuesday’s only.
We carried out an unannounced comprehensive inspection on 14 July 2015 in response to concerns that were reported to CQC about the fundamental standards of quality and safety that were not being met. On the day of our inspection the dentist (who was also the manager and provider) was on leave. When we arrived, staff contacted the provider on the telephone and we spoke to them and explained we would be carrying out a comprehensive inspection.
The inspection took place over one day and was carried out by a CQC inspector and a dentist specialist advisor.
We reviewed four NHS Friends and Family test cards completed by patients and one review posted on the NHS Choices website. Patients gave positive views about the care and experience of the practice.
Our key findings were:
- Staff told us the relevant checks to ensure that the persons being recruited were suitable and competent for the role, however there were no records kept.
- The practice worked well with other providers and completed all the relevant information required.
- The practice did not have robust arrangements in place to manage the risk of spread of infection.
- The practice did not have robust arrangements for disposal of clinical waste.
- There were limited governance arrangements in place to guide the management of the practice.
- The practice did not have effective systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
- The monitoring arrangements and audits were not effective in improving the quality and safety of the services
- Appliances and fixtures and fittings in the premises were not being suitably maintained.
We identified regulations that were not being met and the provider must:
- Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
- Ensure a safe system is in place to monitor dental materials
- Ensure a safe system is in place to monitor emergency medicines.
- Ensure waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
- Review the practice’s protocols for undertaking radiography giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
- Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
- Review governance arrangements including the effective use of risk assessments, audits, such as those for infection control, radiographs and dental care records, and staff meetings for monitoring and improving the quality of the care received.
- Review the suitability of all areas of the premises and the fixtures and fittings in the treatment rooms.
- Ensure recruitment checks are recorded and evidence is documented.
- Ensure all staff receive induction and performance appraisals and are suitably supported in undertaking their activities.
You can see full details of the regulations not being met at the end of this report.