We carried out an announced comprehensive inspection on 20 July 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?
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 not 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
Mydentist Millfield Peterborough employs three dentists, one dental nurse and three trainee dental nurses, a hygiene therapist, a receptionist and a part time interpreter. The practice manager is based at the practice three days each week as they also manage a smaller practice in the city owned by the same provider. The practice provides mostly NHS dental services and some private dental services. It opens Monday to Friday 8.30am – 5.30pm.
The practice manager 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 practice is run.
We received feedback from eight patients either in person or via CQC comments cards from patients who had visited the practice in the two weeks before our inspection. They told us staff were welcoming and treated them with dignity and respect. Patients were happy with the standard of dental care they received and felt they received appropriate information.
Our key findings were:
- The practice provided a range of dental services to NHS and private patients within a multi-cultural area of the city. Many patients spoke no or limited English and staff took steps to ensure patients were appropriately supported to understand their care and treatment.
- We found that patients were able to access the service for treatment although we found some patients had difficulties accessing emergency appointments when they required them.
- Procedures for reporting incidents/ accidents and complaints were in place but were not always followed to promote learning and service improvements.
- Some risk assessments were in place and had been regularly reviewed. Although some identified risks had not been assessed and/or actioned.
- There were systems in place for the cleaning and decontamination of dental instruments We found that audits of the procedures were not being closely monitored and some procedures needed to be reviewed.
- Appropriate medicines and life-saving equipment were readily available.
- Patients received care and treatment to promote their dental health in line with clinical guidelines.
- Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in decisions about it
- Patients were treated with dignity and respect and confidentiality of their personal information was maintained
We identified regulations that were not being met and the provider must:
- ensure improvement is made to the procedures for reporting, recording and analysing incidents and accidents so that action is taken to prevent further occurrences, make improvements and share learning.
- ensure a quality monitoring procedure such as the Infection Prevention Society (IPS) audit tool is established to ensure that safe decontamination procedures are being followed.
- ensure improvements to staff records are completed to demonstrate that a full recruitment process is followed.
- ensure that identified fire and environmental risks are assessed and control measures are put in place in a timely manner to reduce any on-going risks to staff and patients.
- ensure that all staff complete the mandatory training and receive an annual appraisal. Inexperienced staff must be adequately supervised and supported.
- ensure that staff recognise and report concerns and complaints raised by patients. Thorough investigations and actions must be completed so that improvements can be made to the service and learning shared.
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:
- Complete a review of the capacity and temperature of the ultrasonic cleaning bath.
- Complete daily temperature checks of the medicines fridge to ensure that medicines are being stored at safe temperatures.
- Raise staff awareness of the practice whistleblowing procedures.
- Review systems in place for repairing faulty equipment to improve timeliness of actions where possible.
- Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
- Review management of clinical waste to ensure it is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
- Review the practice’s legionella risk assessment
- Review records of staff immunity for Hepatitis B so that they are updated.
- Review staff awareness of first aid guidelines, the Mental Capacity Act 2005 and Gillick principles.
- Review access to the practice for patients with a disability and parents using prams.
- Review the patient referrals to ensure they are appropriate and information is complete.
- Review availability of key information to ensure it is available in alternative languages to meet the needs of the diverse cultural groups of registered patients.