Dr A M. Tabrizi Dental Practice Limited

We undertook a follow up focused inspection of Dr A M. Tabrizi Dental Practice Limited on 19 December 2019. 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 who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Dr A M. Tabrizi Dental Practice Limited on 11 July 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 regulations 17 and 18 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 Dr A M. Tabrizi Dental Practice Limited on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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 (requirement notice only). We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

Our findings were:

Are services well-led?

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

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection at our inspection on 11 July 2019.

Background

Dr A M. Tabrizi Dental Practice Limited is in Ipswich and provides NHS and private treatment to adults and children.

There is no level access for people who use wheelchairs or those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in car parks near the practice.

The dental team includes one dentist, three trainee dental nurses, one dental hygienist awaiting GDC registration and the practice manager. The practice has three 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.

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

The practice is open: Monday to Thursday from 9am to 5pm, Friday from 9am to 4pm and alternate Saturdays from 9.30am to 1pm.

Our key findings were:

• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Not all staff had the correct disclosure and barring checks in place. Not all staff had a record of their immunity to hepatitis B recorded in their records. The practice told us they would take action following the inspection to update these.
• The practice had suitable arrangements to ensure the safety of the X-ray equipment and we saw the required information was in their radiation protection file.
• Audit systems had been reviewed with audits of radiography, dental records and infection prevention and control undertaken to improve the quality of the service. There was scope to ensure antimicrobial audits were undertaken.
• No further action had been taken to ensure the six actions identified during the August 2018 fire risk assessment had been reviewed or completed.
• There was no evidence of the hygienist being registered with the General Dental Council (GDC).
• There was limited evidence of support, professional development and supervision for the hygienist or the three trainee dental nurses from the dentist. We were not assured that two of the trainee dental nurses were on established college courses.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Introduce protocols regarding the prescribing of antibiotic medicines.

We carried out this announced inspection on 11 July 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

Dr A M. Tabrizi Dental Practice Limited is in Ipswich and provides NHS and private treatment to adults and children.

There is no level access for people who use wheelchairs or those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in car parks near the practice.

The dental team includes one dentist, three trainee dental nurses, one trainee dental hygienist, one dental therapist, one receptionist and the practice manager. The practice has three 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 34 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with the dentist, three trainee dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday from 9am to 5pm, Friday from 9am to 4pm and alternate Saturdays from 9.30am to 1pm.

Our key findings were:

• We received positive comments from some patients about the dental care they received and the staff who delivered it.
• The provider had infection control procedures which mostly reflected published guidance. The practice carried out infection prevention and control audits, but not as regularly as recommended by guidance.
• The practice appeared clean and well maintained.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider did not have all emergency equipment in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• The provider had systems to help them manage risk to patients and staff.
• The provider had some safeguarding processes. Not all staff were aware of who the safeguarding lead was or knew their responsibilities for safeguarding vulnerable adults and children.
• The appointment system took account of patients’ needs.
• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.
• Systems to ensure the safe recruitment of staff were not robust, as essential pre-employment checks had not been completed.
• Risk assessment to identify potential hazards and audit to improve the service were limited.
• Staff did not receive regular appraisal of their performance and none had personal development plans in place. There were limited systems in place to ensure staff undertook regular training.

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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Review the practice’s safeguarding policy and ensure it takes into account both adults and children.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.