Burnawn House Dental Surgery Also known as Dr. Uche Hildebrand Oguike

We carried out this announced inspection on 16 March 2020 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.

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 this practice was not 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 caring?

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

Are services responsive?

We found this practice was providing responsive 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

Burnawn House Dental Surgery is in Raunds, a small market town in rural Northamptonshire. It provides mostly NHS dental care and treatment for adults and children.

There is one step access to the practice with use of a portable ramp for people who use wheelchairs and those with pushchairs.

Free car parking spaces are available in a public car park and on the street within a close distance of the practice.

The dental team includes two dentists, one dental nurse and one receptionist. The practice also uses locum/agency dentists and dental nurses when required.

The principal dentist has responsibility for practice management. The practice has two treatment rooms, both on ground floor level.

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 17 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, the dental nurse, and the receptionist. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5.30pm. It closes during lunchtimes between 12.30pm to 2pm.

Our key findings were:

• We found that most areas of the practice were visibly clean, although we found some areas that had been missed when cleaning of the general areas of the premises took place.
• The provider had infection control procedures which mostly reflected published guidance. We noted that tiled flooring in one of the treatment rooms was not adhering to best practice.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available however and we found some that had expired.
• Systems to manage risks to patients and staff were not all working effectively.
• The provider did not have suitable safeguarding processes and therefore, staff were not sufficiently aware of their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures, although a policy was not held. Only one staff member had been appointed since the current provider had taken ownership. Checks were completed except for references. Agency staff had checks in place.
• We saw evidence to support that clinical staff provided patients’ care and treatment in line with current guidelines. We also noted exceptions where guidance was not followed. One of the clinicians did not use dental dam (for root canal treatment) and they did not ensure that alternate measures used to protect the airway were recorded in written patient records.
• Staff provided preventive care and supported patients to ensure better oral health.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider asked staff and patients for feedback about the services they provided.
• The provider had not received any formal complaints.
• The provider did not demonstrate effective leadership or a culture of continuous improvement.
• The provider demonstrated they were taking some responsive actions after the day of our visit and told us they would continue to address these.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• 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:

• Take action to ensure dentists are aware of the guidelines issued by the British Endodontic Society for the use of rubber dam for root canal treatment.
• Improve the practice's recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Improve the practice's waste handling protocols to ensure waste is segregated and disposed of in compliance with the relevant regulations, and taking into account the guidance issued in the Health Technical Memorandum 07-01.

• Take action to ensure that clinicians take into account the guidance provided by the Faculty of General Dental Practice when completing dental care records.
• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Take action to ensure the service takes into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.