We carried out this announced focused inspection on 6 October 2021 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.
As part of this inspection we asked the following questions
• Is it safe?
• Is it effective?
• 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 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 well-led?
We found this practice was not providing well-led care in accordance with the relevant regulations.
Background
Beehive Dental Practice also known as Garden City Dental is in Welwyn Garden City and provides NHS and private dental care and treatment for adults and children.
There are two small steps into the practice with a ramp for people who use wheelchairs and those with pushchairs. However, there are no disabled toilet facilities at the practice. Car parking spaces are available at the rear of the practice.
The dental team includes four dentists, five dental nurses including a trainee, one dental hygienist, three receptionists and a full-time practice manager. The practice has four treatment rooms all on the ground floor.
The practice is owned by a partnership and as a condition of registration must have a person registered with the CQC as the registered manager. Registered managers 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 registered manager at Beehive Dental Practice is the practice manager.
During the inspection we spoke with three dentists, one dental nurse, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday, Tuesday and Thursday from 8.30am to 5.30pm.
Wednesday from 8.30am to 8pm.
Friday from 8.30am to 4pm.
Saturday from 9am to 12pm.
Our key findings were:
- The practice appeared to be visibly clean and well-maintained.
- The provider had infection control procedures, but some improvements were needed.
- Staff knew how to deal with medical emergencies, however the management of emergency equipment required improvement.
- The provider had some systems to help them manage risk to patients and staff.
- The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Not all staff had received training to a level suitable to their role.
- The provider had staff recruitment procedures which reflected current legislation although improvement was needed in the oversight of staff files.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- Staff provided preventive care and supported patients to ensure better oral health.
- The provider did not have effective leadership and a culture of continuous improvement.
- Staff felt involved and supported and worked as a team.
- The provider asked staff and patients for feedback about the services they provided.
- The provider dealt with complaints positively and efficiently.
The provider accepted the clinical and managerial issues that we identified and took immediate action after our inspection to begin to address these. We were sent evidence which demonstrated that many of the shortfalls have since been addressed and risks mitigated.
Where evidence is sent that shows the relevant issues have been acted on, we have stated this in our report but we cannot say that the practice is compliant for that key question as this would not be an accurate reflection of what was found on the day of our inspection.
We identified regulations the provider was not complying with. They must:
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Full details of the regulation the provider was not meeting are at the end of this report.
There were areas where the provider could make improvements. They should:
- Improve the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’ In particular the validation of manual cleaning procedures.
- Improve the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
- Take action to ensure audits of radiography and the prescribing of antibiotic medicines are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.