Lynwood Dental Practice

We undertook a follow up desk-based inspection of Lynwood Dental Practice on 26 March 2020. 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.

We undertook a comprehensive inspection of Lynwood Dental Practice on 15 October 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 well-led care and was in breach of regulation 17 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 Lynwood Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked: Remove as appropriate:

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

Our findings were:

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breach we found at our inspection on 15 October 2019.

Background

Lynwood Dental Practice is in Hightown, Merseyside and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking is available near the practice. The ground floor surgery is accessible for wheelchair users.

The dental team includes two dentists, five dental nurses, three of whom are trainees, and two dental hygiene therapists. 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.

For this inspection we spoke with the principal dentist. We also reviewed changes made to practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday 9am to 6pm and on Friday from 9am to 5pm.

Our key findings were:

• The infection audit control tool used by the practice was now the updated version which included a statement of any actions required. Staff had been encouraged to complete this to ensure any required actions were identified and recorded.
• All appropriate medicines and life-saving equipment were available, as described in recognised guidance. The list used to check medicines and equipment against had been updated. Glucagon was being stored in the fridge and the temperature of the fridge was monitored daily.
• The provider had systems to help them manage risk to patients and staff. These had been reviewed with staff. For example, staff were told that they should not be dismantling any sharps, including matrix bands.
• All required recruitment records were in place for all staff working at the practice. A training matrix was now in place to give the provider oversight of any staff training requirements.
• A Legionella risk assessment had been booked for the practice, following changes to the building, for example, the provision of a new toilet facility. This assessment had been postponed due to the Corona virus outbreak. Paperwork from the risk assessor was provided to demonstrate that all reasonable steps had been taken and that a full assessment would be carried out as soon as this was permitted.
• There was a system in place to monitor referrals to specialist or secondary care. All staff were familiar with this so they could make checks in the absence of any colleague.
• The complaints procedure had been reviewed and updated to ensure this met the guidance on NHS complaints handling and protocol.
• Clinical waste audits were in place.
• Policies had been reviewed and staff were updated on changes made to these.
• The system for receiving alerts and updates in the practice had been reviewed and updated to ensure staff had access to these and that they were printed off for staff to refer to.

We carried out this announced inspection on 15 October 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 providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was 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

Lynwood Dental Practice is in Hightown, Merseyside and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking is available near the practice. The ground floor surgery is accessible for wheelchair users.

The dental team includes two dentists, five dental nurses, three of whom are trainees, and two dental hygiene therapists. The practice has two operational 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 21 CQC comment cards filled in by patients. All patients who completed comment cards expressed positive views of the practice. We received 45 instances of positive feedback from patients, through our on-line ‘Share your experience’ web form. We also received seven instances of negative feedback.

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

The practice is open: Monday to Thursday 9am to 6pm and on Friday from 9am to 5pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. The infection control audit did not have a statement of any actions required and had not identified issues highlighted by this inspection.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were not available, as described in recognised guidance.
• The provider had systems to help them manage risk to patients and staff. These were not fully effective or observed by all staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures in place. These were not universally followed. Staff recruitment records were not complete.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• There was no clear system in place to monitor referrals to specialist or secondary care.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff provided preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and worked towards continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided. Feedback we received from patients showed they valued the services provided by the practice. Some feedback indicated that the provider did not always manage verbal complaints effectively to resolution.
• The provider had suitable information governance arrangements.

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 is not meeting are at the end of this report.

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

• Implement processes and systems for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service. Particularly, in relation to verbal feedback from patients, and recording this as a complaint, where issues raised cannot be addressed within 24 hours.