Archived: Elm Street Dental Surgery

We carried out this announced inspection on 24 February 2020 under section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a Care Quality Commission, (CQC), inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

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

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

Elm Street Dental Surgery is in Ipswich, Suffolk and provides NHS and private dental care and treatment for adults and children.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces are available in public car parks near the practice.

The dental team includes one dentist, two dental nurses, one trainee dental nurse and the practice manager. The practice has two treatment rooms, we were told only one room is in use.

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.

On the day of inspection, we collected 48 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist and two dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5.30pm.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The practice appeared to be visibly clean.
• Not all staff knew their responsibilities for safeguarding vulnerable adults and children.
• Infection control procedures did not reflect published guidance and were not regularly reviewed.
• Systems to ensure all equipment used to decontaminate dental instrument were regularly serviced were not in place. Daily tests to ensure this equipment was validated were not in place.
• The risk assessment for handling sharp instruments did not include a list of specific sharp items and was not in line with the processes in place at the practice.
• The practice decompressor had not been serviced since 2012.
• Five year fixed wire testing was three years overdue.
• There were limited systems in place to mitigate the risks of legionella and no legionella risk assessment had been undertaken.
• Staff had not received recent emergency resuscitation and basic life support training; we were not assured they all knew how to deal with emergencies.
• Essential medical emergency equipment such as an oropharyngeal airway and clear face masks were out of date. There was no paediatric self-inflating bag. Emergency medicines to manage a severe allergic reaction and medicines to manage a seizure were out of date. The practice did not have the appropriate medicines to relieve the symptoms of asthma or COPD. Glucagon was stored in a fridge, but there was no process in place to monitor the temperatures of the fridge. Following the inspection, the practice sent confirmation that some of these had been replaced.
• The practice did not have an automated external defibrillator (AED). There was no risk assessment in place to mitigate the risk of not having an AED on the premises.
• The provider had limited systems to help them manage risks to patients and staff.
• Audits to assess the quality of service were limited.
• There was not a culture of continuous improvement.
• We were not assured the dentist was aware of current guidance with regards to prescribing medicines. Antimicrobial prescribing audits were not undertaken.
• We were not assured staff had knowledge of the recognition, diagnosis and early management of sepsis. The dentist was not aware of the Local Safety Standards for Invasive Procedures' (LocSSIPs) for wrong site extraction in dentistry.
• Staff recruitment procedures did not reflect current legislation. There were no details of Disclosure and Barring Service checks recorded in two staff records, no evidence of photographic identification in any staff records and no evidence of Hepatitis B immunity in two clinical staff records. References had not been obtained for the newest member of staff.
• The practice had some arrangements to ensure the safety of the X-ray equipment. There was no evidence of Health and Safety Executive (HSE) notification, Radiation Protection Adviser (RPA) or critical examination checks of the X-ray equipment. Following the inspection the practice sent information of HSE notification and a critical examination check. Radiography audits had not been completed in line with current guidance and legislation.
• There was no evidence that the clinical staff completed continuing professional development in respect of dental radiography.
• The dentist used rotary root canal instruments when providing root canal treatment. These were not in line with guidance from the British Endodontic Society. The dentist did not use dental dam. Where dental dam had not been used, there was no risk assessment in place to assess and mitigate the risks.
• Patients commented that staff treated them with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider is not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Improve staff awareness of their responsibilities in relation to the Duty of Candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.