The Care Quality Commission
  • Doctor
  • Independent doctor

Oxforce Limited

Overall: Good read more about inspection ratings

69-71 Banbury Road, Oxford, Oxfordshire, OX2 6PE 07868 346821

Provided and run by:
Oxforce Limited

All Inspections

21 July 2023

During an inspection looking at part of the service

This service is rated as Good overall. (Previous inspection November 2022 – Good)

The key questions are rated as:

Are services safe? – Good

We carried out an announced focused inspection at Oxforce Limited to follow up on a breach of regulations identified during our previous inspection and to ensure improvements made by November 2022 were being sustained.

At our previous comprehensive inspection in July 2022 we found the provider was not meeting legal requirements and regulations associated with the Health and Social Care Act 2008. We took enforcement action against the provider and the overall rating was Inadequate. We conducted a follow up inspection in November 2022, where we identified significant improvements and this was reflected in a new overall rating of Good. However, there remained a breach of regulation related to insufficient infection control processes.

Oxforce Limited provides patients with oral and maxillofacial surgery (maxillofacial care is related to the diagnosis and treatment of patients with diseases affecting the mouth, jaws, face and neck). Dental implants are also available from the service (a dental implant is placed directly into a patient’s jawbone, replacing missing teeth or roots). Patients can receive assessments during consultations and x-rays where necessary from shared services with an orthodontist practice on the same premises. Surgery is undertaken in the provider’s own surgical room and using their own equipment. A dental nurse and personal assistant are employed. In addition, a consultant anaesthetist is sub-contracted when conscious sedation is required (a form of anaesthesia that is an alternative to general anaesthetic). On average, surgery and consultations are provided on 5 to 7 days a month. This service is registered with CQC under the Health and Social Care Act 2008 in respect of the following regulated activities: Treatment of disease, disorder or injury, Diagnostic and screening procedures and Surgical procedures.

The lead clinician is the only staff member undertaking surgery and is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • Infection control processes, specifically those related to the decontamination of medical instruments, were in place and in line with guidance.
  • There was appropriate recording of care and treatment which ensured patients were assessed and safe to undergo treatment.
  • Governance processes were embedded to ensure oversight of the service.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Healthcare

4 November 2022

During a routine inspection

This service is rated as Good overall. We carried out an announced follow up comprehensive inspection at Oxforce Limited on 4 November 2022. This was following a previous inspection in July 2022 where we rated the service Inadequate and placed the location into special measures.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

This inspection identified significant improvements to the safety and effectiveness of the service. At our previous inspection in July 2022 we found the provider was not meeting legal requirements and regulations associated with the Health and Social Care Act 2008. We took enforcement action against the provider. We had previously inspected the service on three occasions, in November 2017 and July 2018. The July 2018 inspection was an unrated inspection to identify if improvements we instructed the provider to take had been implemented following the November 2017 inspection. The provider was found to be meeting regulations at the July 2018 inspection.

Oxforce Limited provides patients with oral and maxillofacial surgery (maxillofacial care is related to the diagnosis and treatment of patients with diseases affecting the mouth, jaws, face and neck). Dental implants are also available from the service (a dental implant is placed directly into a patient’s jawbone, replacing missing teeth or roots). Patients can receive assessments during consultations and x-rays where necessary from shared services with an orthodontist practice on the same premises. Surgery is undertaken in the provider’s own surgical room and using their own equipment. A dental nurse and personal assistant are employed. In addition, a consultant anaesthetist is sub-contracted when conscious sedation is required (a form of anaesthesia that is an alternative to general anaesthetic). Surgery and consultations are provided five to seven days a month.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the following regulated activities: Treatment of disease, disorder or injury, Diagnostic and screening procedures and Surgical procedures

The lead clinician is the only staff member undertaking surgery and is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • There were significant improvements to the service.
  • Risks to patients had been mitigated and systems were implemented to ensure monitoring of safety took place.
  • Staff background checks, training and development needs were identified and monitored.
  • Infection control processes were appropriately managed and maintained. However, we found a concern regarding the decontamination of equipment.
  • The premises were well maintained and equipment was maintained and serviced.
  • There was appropriate recording of care and treatment which ensured patients were assessed and safe to undergo treatment, although not all recording of patient care was standardised on patient notes.
  • There was improved monitoring of care and treatment.
  • There were processes to support patients in accessing care and services.
  • There were processes to support patients before and after treatment.
  • There was positive feedback from patients regarding the care they received.
  • Governance processes were improving to ensure oversight of the services provided.

The area where the provider must make improvements as they are in breach of regulations is:

  • Ensure there are appropriate systems operated and in place to protect patients and staff from healthcare associated infection risks.

The provider should also consider:

  • Implementing further monitoring systems to assess the quality of care provided.
  • Standardising the recording of X-rays in patients records.

This service was placed in special measures in August 2022. Sufficient improvements have been made such that we have been able to rate the service Good. Therefore we are removing the service from special measures.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

29 July 2022

During a routine inspection

This service is rated as Inadequate overall. We carried out an announced comprehensive inspection at Oxforce Limited as part of our inspection programme. This was the provider’s first rated inspection.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

This inspection in August 2022 was carried out to provide a rating for the service and check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. We have previously inspected the service on two occasions, in November 2017 and July 2018. The July 2018 inspection was an unrated inspection to identify if improvements we instructed the provider to take had been implemented following the November 2017 inspection. The provider was found to be meeting regulations at the July 2018 inspection. _

Oxforce Limited provides patients with oral and maxillofacial surgery (maxillofacial care is related to the diagnosis and treatment of patients with diseases affecting the mouth, jaws, face and neck). Dental implants are also available from the service (a dental implant is placed directly into a patient’s jawbone, replacing missing teeth or roots). Patients can receive assessments during consultations and x-rays where necessary from shared services with an orthodontist practice on the same premises. Surgery is undertaken in the provider’s own surgical room and using their own equipment. A dental nurse and personal assistant are employed. In addition, a consultant anaesthetist is sub-contracted when conscious sedation is required (a form of anaesthesia that is an alternative to general anaesthetic). Surgery and consultations are provided five to seven days a month.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the following regulated activities: Treatment of disease, disorder or injury, Diagnostic and screening procedures and Surgical procedures

The lead clinician is the only staff member undertaking surgery and is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

  • There were significant risks identified including with the use of specific medicines, infection control processes and risks associated with fire management procedures. These risks were not independently identified or managed by the provider.
  • The premises were well maintained and equipment was maintained and serviced.
  • There were insufficient checks on patients prior to receiving care and poor recording of treatment.
  • Monitoring of care and treatment was not identifying risks or areas for quality improvement.
  • Staff training was not monitored and there was no system to identify support and development needs for staff.
  • There were processes to support patients in accessing care and services.
  • There were processes to support patients before and after treatment.
  • There was positive feedback from patients regarding the care they received.
  • Governance processes were not in place to ensure oversight of the services provided.

The areas where the provider must make improvements as they are in breach of regulations are:

  • The provider must operate systems and processes to assess, monitor and improve the quality and safety of the services provided, and assess, monitor and mitigate the risks relating to the health, safety and welfare of service users.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

31 July 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection of Oxforce Limited on 24 November 2017 and found that the service was not meeting regulations and requirement notices were issued. On 9 May 2018 an announced focussed inspection was carried out to follow up on the requirement notices and found that the issues we identified at the previous comprehensive inspection had not been resolved. The full reports from these inspections can be found by selecting the ‘all reports’ link for Oxforce Limited on our website at ww.cqc.org.uk.

This inspection was an announced focused inspection carried out on 31 July 2018 to follow up on a warning notice the Care Quality Commission served on 18 May 2018 following the focussed inspection in relation to Regulation 17 (1) Good Governance of the Health and Social Care Act 2008. The practice was required to correct the regulatory breaches set out in the warning notice by 29 June 2018. At this inspection we found that the provider had taken action in respect of the warning notice.

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations

Are services well-led?

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

Our key findings were:

  • Infection prevention control processes met the requirements set out in the Health Technical Memorandum – HTM01-05.
  • There was a process in place to ensure oversight that training and competencies were maintained.
  • There were suitable governance frameworks in place to support the delivery of services.

9 May 2018

During an inspection looking at part of the service

We undertook a focussed follow up inspection on 9 May 2018 to check whether improvements to the service had been made. We found a continued breach of regulations.

Our findings were:

Are services safe?

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

Are services effective?

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

Are services well-led?

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

We carried out an announced comprehensive inspection on 24 November 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led? We found the service was not meeting regulations and issued a requirement notice. We checked these areas as part of this follow up focused inspection and found this had not been resolved.

The premises are leased and shared with an orthodontic practice. The services are provided on the second floor.

There is aregistered manager in post. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We did not speak to patients as part of this inspection.

Our key findings were:

  • Some risks associated with the provision of services were well managed. However, there was not a full assessment of the potential risks posed by infection control.
  • There were not adequate governance arrangements in place in aspects of the service. Specifically there was a lack of systems to identify and deliver staff training. This led to a lack of support for staff and a lack of monitoring in relation to their skills and knowledge.

We identified regulations that were not being met and the provider must:

  • The registered person must ensure systems and processes are established and operated effectively to ensure they assess, monitor and mitigate all risks to patients and others who may be at risk.

You can see full details of the regulations not being met at the end of this report

There were areas where the provider could make improvements and should:

  • Review systems for checking staff records for any vaccinations required to deliver care available for monitoring purposes.

24 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 24 November 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not always providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This was the first inspection undertaken at this service.

Oxforce Limited provides patients with oral and Maxillofacial surgery (Maxillofacial care is related to the diagnosis and treatment of patients with diseases affecting the mouth, jaws, face and neck). Patients can receive assessments during consultations and x-rays where necessary from shared services with an orthodontist practice on the same premises. Surgery is undertaken in the provider’s own room and using their own equipment. A dental nurse and personal assistant are employed. In addition a consultant anaesthetist is sub-contracted when conscious sedation is required (a form of anaesthesia that is an alternative to general anaesthetic).

The premises are leased and shared with an orthodontal practice. The services are provided on the second floor.

Our key findings were:

  • The provider had systems in place to identify and learn from clinical practice in order to improve services where necessary.
  • Some risks associated with the provision of services were well managed. However, there was not a full assessment of the potential risks posed by infection control.
  • Prescribing was undertaken safely, although the storage of blank prescription forms was not appropriate.
  • Assessments of patient’s treatment options and treatment planning were thorough and followed national guidance.
  • The necessary checks required on staff who provide care were not in place.
  • Patients received full and detailed explanations of any diagnoses and treatment options.
  • The service was caring, person centred and compassionate.
  • There were processes for receiving and acting on patient feedback.
  • There were not adequate governance arrangements in place in many aspects of the service. This led to a lack of support for staff and a lack of monitoring in relation to their skills and knowledge.

We identified regulations that were not being met and the provider must:

  • The provider must operate systems and processes effectively and ensure they assess, monitor and mitigate all risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activities.

There were areas where the provider could make improvements and should:

  • Review the complaints process to ensure patients understand the process and are aware of their rights.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice