Dentalcare Bradford on Avon

We carried out this announced inspection on 7 January 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 not 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

The Dental Company Limited is in Bradford-on-Avon and provides private dental care and treatment for adults.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for people with disabilities, are available near the practice.

The dental team includes seven dentists, four dental nurses, two student dental nurses, two dental hygienists, three receptionists, a practice co-ordinator and a practice manager. The practice has four treatment rooms.

The practice is owned by an organisation 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 The Dental Company Limited is the practice manager.

On the day of inspection, we collected four CQC comment cards filled in by patients and spoke with five other patients.

During the inspection we spoke with four dentists, two dental nurses and one trainee dental nurse, one dental hygienist, two receptionist, the practice manager and the provider. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday, Tuesday, Thursday, Friday – 8.30am to 5.30pm
• Wednesday 8.30am to 6.00pm
• The practice is closed at weekends.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had infection control procedures which could be improved to reflect published guidance.
• Staff knew how to deal with emergencies, but most staff training had lapsed and there had been no training together as a team. Most, but not all, required medicines and life-saving equipment were available.
• The provider had some systems to help them manage risk to patients and staff. However, these needed to be improved.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Most members of staff had not completed safeguarding training for either children or vulnerable adults.
• The provider did not have staff recruitment procedures which reflected current legislation.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took sufficient care to protect their privacy. Patients personal information was handled and stored safely.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system could be improved.
• The provider did not have effective leadership or a culture of continuous improvement.
• Staff did not feel involved or supported but worked well as a team.
• The provider had not asked patients for feedback about the services they provided. Staff feedback was not acquired.
• The provider did not deal with complaints positively or efficiently.
• The provider had some information governance arrangements, but these required improvements.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or investigation.
• Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
• 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.
• Ensure specified information is available regarding each person 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:

• Improve the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Implement audits for the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Implement protocols for the use of closed-circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.

We are mindful of the impact of COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.