Archived: Park Clinic

We undertook a follow up focused inspection of Park Clinic on 2 July 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a CQC inspection manager and a specialist dental adviser.

We undertook a comprehensive inspection of Park Clinic on 27 February 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing safe, effective or well led care and was in breach of regulations 12 (Safe care and treatment), 17 (Good governance) and 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Park Clinic on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it effective?

• Is it well-led?

Our findings were:

Are services safe?

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

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 27 February 2019.

Are services effective?

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

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 27 February 2019.

Are services well-led?

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

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 27 February 2019.

Background

Park Clinic is in the Abington area of Northampton and provides private dental treatment to adults and children. The registered provider told us that intravenous sedation services were available.

The practice offers a circumcision service mainly to children and infants for religious, cultural and medical reasons. This service is provided by a consultant urologist. These services had previously been suspended but we were told that they had recommenced. The circumcision service was not included in the providers statement of purpose.

There is stepped access with a removable ramp for people who use wheelchairs and those with pushchairs. There is roadside car parking in the area around the practice.

The dental team includes three dentists (one of whom is a specialist oral surgeon), one trainee dental nurse and a consultant urologist. The practice has two treatment rooms, one of which is on the ground floor.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission 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 Park Clinic is the principal dentist.

During the inspection we spoke with the principal dentist and the trainee dental nurse. 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 7pm

Saturday from 9am to 5pm

Our key findings were:

• Improvements had been made to the provider’s recruitment processes.
• Clinical waste was not segregated appropriately.
• Not all medical emergency equipment was available as described in nationally recognised guidance.
• Audits had either not been completed or did not reflect our findings during the inspection.
• Staff had not received an appraisal.
• The risks associated with Legionella had not been appropriately addressed.
• The process for validating the autoclave did not reflect nationally recognised guidance.
• The provider did not ensure that clinicians held adequate indemnity.
• Governance systems had not been implemented to ensure compliance with the regulations.

We identified regulations the provider was not meeting. 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. After the inspection we served a notice of proposal to cancel the providers registration to provide regulated activities. ​

We carried out this announced inspection on 27 February 2019 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 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 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 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

Park Clinic is in the Abington area of Northampton and provides private dental treatment to adults and children.

The practice provides an intravenous sedation service for nervous patients.

The practice offers a circumcision service mainly to children and infants for religious, cultural and medical reasons. This service is provided by a consultant urologist, although it had been voluntarily suspended by the provider to allow a review of the registration requirements.

There is stepped access with a removable ramp for people who use wheelchairs and those with pushchairs. There is roadside car parking in the area around the practice.

The dental team includes four dentists, three qualified dental nurses (including one locum nurse for sedation) and one trainee dental nurse. The practice has two treatment rooms, one of which is on the ground floor.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission 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 Park Clinic is the principal dentist.

On the day of inspection, we collected 29 CQC comment cards filled in by patients. We also received information from two other patients through the CQC website.

During the inspection we spoke with two dentists and one trainee dental nurse. 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 7pm and Saturday from 9am to 5pm. The practice is closed on Sunday.

Our key findings were:

• There were areas of the practice that did not appear clean.
• The provider had infection control procedures, however we identified some areas which did not reflect published guidance.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available.
• The practice had ineffective systems to help them manage risk to patients and staff.
• The provider had ineffective safeguarding processes and it was not clear if staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had significant gaps in the staff recruitment information required by the Regulations.
• Clinical waste segregation and identification was ineffective.
• Staff took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported.
• The provider asked patients for feedback about the services they provided.
• The provider had suitable information governance arrangements.
• The practice provided intravenous sedation for nervous patients, although this service had not been delivered since 2017.
• The practice provided a circumcision service mainly to children and infants for religious, cultural and medical reasons. This service was provided by a consultant urologist. The systems and processes for gathering consent in relation to circumcision were not effective.
• There was no formal system for the use of interpreter services in the practice.

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

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

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

• Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.

• Review the availability of an interpreter service for patients who do not speak English as their first language.

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.