23 September 2015
During an inspection looking at part of the service
We carried out an unannounced responsive inspection on 23 September 2015 to ask the practice the following key questions; Are services safe and effective?
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.
Background
West Park-Leeds is situated in the West Park area of Leeds. It offers both NHS and private dental care services to patients of all ages. The services provided include preventative advice and treatment, routine restorative dental care, conscious sedation and cosmetic dental treatments.
The practice was a residential property which has been converted to provide primary dental care. There are three treatment rooms, two waiting areas and a reception area. The practice offers full disability access including a ground floor treatment room and disabled toilet facilities.
The practice has two dentists, an anaesthetist, two dental nurses, two receptionists and a practice manager.
The practice owner is the 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 practice is open Monday to Friday 9-00am to 5-00pm.
During the inspection we spoke with one dentist, one dental nurse, the practice manager and one receptionist.
Our key findings were:
- There was no evidence that persons involved in the provision of conscious sedation had the appropriate qualifications, training, competence, skills and experience to do so safely.
- There was no evidence that the anaesthetic machine had been maintained, serviced or calibrated to ensure its safe use.
- Medicines (including those used in conscious sedation) were not stored safely.
- Sedative drugs which were used for conscious sedation appeared not to be titrated to effect. Available records suggested that all patients received the same dose of sedative drugs.
- There was little evidence of effective stock control of some controlled drugs.
- Doses of sedative medicines used for conscious sedation were not adjusted according to the patient’s age or weight.
- There was little evidence that appropriate checks had been undertaken at an assessment appointment. There was no evidence of discussions with patients about other forms of anxiety control.
- There was little evidence of pre-operative checks being carried out prior to the sedation.
- There was limited documented evidence of checks on the patient’s vital signs during the procedure.
- There was no evidence of documented post-operative checks prior to the patient leaving the premises.
- Treatment consent forms were not always completed prior to being signed by the patient.
- The sedation surgery was cluttered and equipment was visibly dusty.
- There were out of date dressings, intravenous cannulas and an intravenous fluid bag in the surgery.
We identified regulations that were not being met and the provider must:
- Ensure all staff who are involved in the provision of conscious sedation have the qualifications, competence, skills and experience to do so safely.
- Ensure that all equipment is maintained and cleaned to ensure its safe use.
- Ensure the proper and safe management of medicines.
- Review the practice’s protocols for conscious sedation, giving due regard to guidelines published by the Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015’.
You can see full details of the regulations not being met at the end of this report.