Archived: Wentworth Dental Practice

We carried out an announced comprehensive inspection on 13 July 2016 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 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 providing well-led care in accordance with the relevant regulations.

Background

Wentworth Dental Practice is an NHS and private dental practice situated in the centre of Easington Colliery, County Durham close to public transport links. The practice has two treatment rooms, both on the ground floor and a decontamination room. There is a reception and waiting area. Staff facilities were also located on the ground floor.

There are three dentists, a practice manager, a receptionist and two dental nurses (one of which is a trainee).

The practice is open:

Monday – Thursday 08:30 –17:30

Friday 08:30 – 14:00.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

During the inspection we received feedback from five patients. The patients were positive about the care and treatment they received at the practice and they told us they were involved in all aspects of their care and all but one patient found the staff to be very friendly, exceptionally caring, they provide a high standard of care and were always treated with dignity and respect.

Our key findings were:

• The practice had systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
• The practice appeared clean and hygienic.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in accordance with the published guidelines.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The practice was well-led and staff felt involved and supported and worked well as a team.
• The governance systems were effective.
• The practice sought feedback from staff and patients about the services they provided.
• There were clearly defined leadership roles within the practice.

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

• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references and immunisation status are suitably obtained and recorded.
• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references and immunisation status are suitably obtained and recorded.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

We carried out an unannounced responsive inspection on 30 June 2016 to ensure the practice was providing safe care in respect of the regulations; we did not inspect other aspects of the service.

Our findings were:

Are services safe?

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

Background

Wentworth Dental Practice is an NHS and private dental practice situated in the centre of Easington Colliery, County Durham close to public transport links. The practice has two treatment rooms, both on the ground floor and a decontamination room. There is a reception and waiting area. Staff facilities were also located on the ground floor.

There are three dentists, a practice manager, a receptionist and two dental nurses (one of which is a trainee).

The practice is open:

Monday – Thursday 08:30 –17:30

Friday 08:30 – 14:00.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

Our key findings were:

• There were sufficient numbers of staff to meet the needs of patients.
• Governance arrangements were in not place for the smooth running of the practice; the practice did not have a structured plan in place to audit quality and safety including infection control. The surgeries were clutterd and visibly dirty.
• Staff were not up to date with mandatory training in infection prevention and control or safeguarding.
• No Legionella risk assessment had been carried out.
• Several emergency medicines were out of date.
• Daily and weekly checks on the decontamination equipment were not carried out.

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

• Ensure checks of all medical emergency medicines and equipment are established to manage medical emergencies, giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).
• Ensure the practice’s infection prevention and control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Ensure that all staff undertake relevant training, to an appropriate level, in safeguarding of children and vulnerable adults. Ensure that systems and processes are established and operated effectively to safeguard patients from abuse and review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Ensure COSHH risk assessments are implemented for all materials used within the practice. Review the practice responsibility in regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Ensure the practice undertakes a Legionella risk assessment, giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’ the HSE Legionnaires’ disease. Approved Code of Practice and guidance on regulations L8.
• Ensure the process and procedures for domiciliary care for patients who could no longer access their services are implemented and complete risk assessments in line with the guidelines for the delivery of a domiciliary oral healthcare service 2009.

We found this practice was not providing safe care in accordance with the relevant regulations and identified a regulation was not being met. We took urgent enforcement action to suspend the practice for two weeks to allow improvements to be made.

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

• Review dental care records to ensure they are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping. Adopt an individual risk based approach to patient recalls having regard to National Institute for Health and Care Excellence (NICE) guidelines.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘delivering better oral health: an evidence-based toolkit for prevention’.