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Inspection Summary


Overall summary & rating

Updated 29 April 2019

We carried out this announced inspection on 5 March 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

Church Street Dental Care is in Littleborough, Lancashire and provides private treatment for adults and children.

There is single step access into the practice. Car parking is available near the practice on local side streets.

The dental team includes the principal dentist, four dental nurses (one of whom is a trainee) and one dental hygienist. The practice has two treatment rooms.

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 14 CQC comment cards filled in by patients. All comments received were complimentary about the service being provided.

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

The practice is open:

Monday by appointment only.

Tuesday 10am to 7:30pm, Wednesday 10am to 2:30pm, Thursday 9am to 5pm and Friday 8am to 4pm.

Our key findings were:

  • The practice appeared clean and well maintained.
  • The provider had infection control procedures which could be brought fully in line with guidance.
  • Staff knew how to deal with emergencies. The management of the medical emergency kit was not in line with recommended guidance.
  • The practice had systems to help them manage risk but improvement was needed.
  • The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • The provider’s recruitment procedures could be improved.
  • Improvement was required to systems in place to confirm staff immunity.
  • Clinical awareness of the National Institute for Clinical Excellence (NICE) and The Faculty of GeneralDental Practice UK (FGDP (UK) was not embedded.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • Improvements could be made to delivering preventive care and support to patients to ensure better oral health in line with recommended guidance.
  • The appointment system took account of patients’ needs.
  • Some areas of leading the practice and managing systems and processes could be improved.
  • The practice’s systems for continuous improvement were not effective.
  • Staff felt involved and supported and worked well as a team.
  • The provider asked staff and patients for feedback about the services they provided.
  • The provider had systems to deal with complaints positively and efficiently.
  • The provider had suitable information governance arrangements.

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

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 the practice’s systems for environmental cleaning taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices. In particular: the storage of mops.
  • Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account guidance issued by the National Institute for Clinical Excellence (NICE).
  • Review 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. In particular: register the use of X-ray equipment as required, with the Health and Safety Executive.
Inspection areas

Safe

Improvements required

Updated 29 April 2019

We found that this practice was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the Requirement Notices section at the end of this report).

The systems in place to identify, report and learn from incidents were not embedded. Protocols were in place, but staff were not aware of what constituted an incident or significant event or what the reporting process was.

The practice had systems to help them manage risk. We identified where improvements could be made to fire safety systems, risk awareness and assessment, safer sharps systems and the risk associated with hazardous materials used at the practice and appropriate verification of staff immunity to the Hepatitis B vaccination.

The provider was not using dental dams in line with recommended guidance.

Staff received training in safeguarding people and knew how to recognise the signs of abuse and how to report concerns.

Staff were qualified for their roles. The practice completed essential recruitment checks but improvements could be made to ensure appropriate records are sourced and kept.

Premises and equipment were clean and properly maintained. The practice followed national guidance for cleaning, sterilising and storing dental instruments. Improvements could be made to infection prevention and control processes to bring them in line with guidance.

The practice had suitable arrangements for dealing with medical and other emergencies. The systems for managing the medical emergency kit and the handling and dispensing of medicines were not currently managed in line with recognised guidance.

There was no system in place for receiving and acting on safety alerts.

We identified an area of non-compliance and an equipment safety concern in respect to the X-ray equipment used at the practice. The provider assured us these matters would be actioned without delay.

Effective

Improvements required

Updated 29 April 2019

We found that this practice was not providing effective care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the Requirement Notices section at the end of this report).

The dentist assessed patients’ needs and provided care and treatment mostly in line with recognised guidance but there were areas, where knowledge of guidance was limited. Clinical awareness of the National Institute for Clinical Excellence (NICE) and The Faculty of General Dental Practice UK (FGDP (UK) guidance could be improved.

The process in place to ensure a patients’ medical history was kept up to date was inconsistent and not in line with recommended guidance.

Improvements could be made to delivering preventive care and support to patients to ensure better oral health in line with recommended guidance.

Patients described the treatment they received as excellent, very good and professional.

The practice occasionally used agency staff; the provider had no evidence to show that locum staff received an induction to ensure that they were familiar with the practice’s procedures.

The dentist discussed treatment with patients so they could give informed consent. Consent was inconsistently recorded in patient care records and could be improved.

The practice had clear arrangements when patients needed to be referred to other dental or health care professionals.

The provider supported staff to complete training relevant to their roles and had systems to help them monitor this.

Caring

No action required

Updated 29 April 2019

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

We received feedback about the practice from 14 people. Patients were positive about all aspects of the service the practice provided. They told us staff were lovely, caring and professional.

They said that they were given helpful, honest explanations about dental treatment, and said their dentist listened to them. Patients commented that they made them feel at ease, especially when they were anxious about visiting the dentist.

We saw that staff protected patients’ privacy and were aware of the importance of confidentiality. Patients said staff treated them with dignity and respect.

Responsive

No action required

Updated 29 April 2019

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

The practice’s appointment system took account of patients’ needs. Patients could get an appointment quickly if in pain.

The practice had carried out a disability access audit. The audit had identified some areas where reasonable adjustments could be made for patients with disabilities. These had not been acted upon.

The practice had access to telephone interpreter services and had arrangements to help patients with sight or hearing loss.

The practice took patients views seriously. They had systems to manage compliments from patients. The practice had received no complaints in the past 12 months.

Well-led

Improvements required

Updated 29 April 2019

We found that this practice was not providing well-led care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the Requirement Notices section at the end of this report).

Some systems of clinical governance were not fully understood by staff and were not effectively monitored to ensure the practice was performing in line with recommended guidance and legislation. For example:

  • Infection prevention and control processes.
  • Systems in place to manage the medical emergency kit.

There were processes for managing risks but these required embedding and updating to reflect the practice procedures. For example:

  • Systems in place to manage sharps had not been risk assessed and were not carried out in line with recommended guidance.
  • A full review of the risks associated with materials identified under COSHH had not taken place.

Patient dental care records were stored securely.

There were systems and processes for learning, continuous improvement and innovation but these were not embedded or responded to appropriately. We reviewed audits and assessments relating to fire safety and disability access. These had recommendations which had not been addressed.

There was a clearly defined management structure and staff felt supported and appreciated.