Linden Lodge Dental Care Limited

We undertook a focused inspection of Linden Lodge Dental Care on 3 September 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 Linden Lodge Dental Care on 12 February 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 Regulation 17 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 Linden Lodge Dental Care on our website www.cqc.org.uk.

As part of this inspection we asked: Remove as appropriate:

• 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. 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 providing well-led care in accordance with the relevant regulations. They had made sufficient improvements to put right the shortfalls and had responded to the regulatory breach we found at our inspection on 12 February 2019.

Background

Linden Lodge Dental Care is in Clevedon and provides NHS and private treatment to adults and children.

There are steps into the practice with hand rails available for assistance. For people who use wheelchairs, and those with pushchairs, level access is provided by a portable ramp which can be erected for this purpose. Free on road car parking is available near the practice.

The dental team includes three dentists and a visiting dentist with special interest in orthodontics, four dental nurses one trainee dental nurse, one dental hygienist, a practice manager and one receptionist. The practice has four treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission 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 Linden Lodge Dental Care is the practice manager.

During the inspection we spoke with two dentists, two dental nurses, one trainee dental nurse, one 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 - Thursday 09:00am – 1.00pm and 2.00pm - 5.30pm
• Friday 09.00am – 1.00pm and 2.00pm - 4.00pm
• Closed at weekends

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had reviewed, and improved safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had improved existing, and implemented new, systems to help them manage risk to patients and staff.
• The provider had reviewed and improved staff recruitment procedures to ensure all aspects of the practice policy and were met.
• Staff felt involved, supported, worked well as a team and had been involved in the recent changes to meet the regulatory breach.
• The provider had a registered manager in place who provided effective leadership and a culture of continuous improvement.
• The provider had suitable information governance arrangements.

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

• Take action to ensure where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Improve the practice arrangements for ensuring good governance and leadership are sustained when the practice manager is away.

We carried out this announced inspection on 12 February 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 this practice was 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 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

Linden Lodge Dental Care is in Clevedon and provides NHS and private treatment to adults and children.

There are steps into the practice with hand rails available for assistance. For people who use wheelchairs, and those with pushchairs, level access is provided by a portable ramp which can be erected for this purpose. Car parking spaces are available in the road near the practice.

The dental team includes three dentists and a visiting dentist with special interest in orthodontics, four dental nurses and one trainee dental nurse, one dental hygienist, a practice manager and one receptionist. The practice has four treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission 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.

At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered.

On the day of inspection, we collected 41 CQC comment cards filled in by patients and spoke with three other patients.

During the inspection we spoke with three dentists, three dental nurses and the trainee dental nurse, one dental hygienist, one 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 - Thursday 09:00am – 1.00pm and 2.00pm - 5.30pm
• Friday 09.00am – 1.00pm and 2.00pm - 4.00pm
• Closed at weekends

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had limited systems to help them manage risk to patients and staff.
• The provider had some safeguarding processes and staff demonstrated limited knowledge of their responsibilities for safeguarding vulnerable adults and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had limited leadership and evidence of continuous improvement was minimal.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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
• Send CQC a written report setting out what governance arrangements are in place and the plans to make improvements.

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 fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.

• Review the practice safeguarding policy and ensure it takes into account both adults and children and contains the relevant information for reporting suspected abuse and includes the local contact numbers for children and vulnerable adults.

• Review staff training to ensure all the staff have understood training received in the safeguarding of children and vulnerable adults and can apply it in practice.

• Review the practice infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’ In particular relating to decontaminating in surgery.

• Review the practice Legionella risk assessment and implement any recommended actions, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’

• Review the practice recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice. In particular relating to Disclosure and Barring Checks (DBS) being completed prior to employment.

• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice. Introduce an annual antimicrobial prescribing audit.

• Review the practice arrangements for ensuring good governance and leadership are sustained in the longer term.

• Review the provider's registration conditions to ensure the regulated activities at Linden Lodge Dental Care are managed by an individual who is registered as a manager.

• Review the practice protocols to ensure audits of record keeping are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.