Bramwell Dental Practice

We carried out this announced comprehensive inspection on 9 November 2022 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 practice was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a Care Quality Commission, (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:

• The dental clinic was visibly clean and well-maintained.
• The practice had infection control procedures which mostly reflected published guidance.
• Staff knew how to deal with medical emergencies. Appropriate medicines and most life-saving equipment were available. However oropharyngeal airways and paediatric masks were not available on the day and the temperature of the fridge where the medicine used to manage low blood sugar was not monitored to ensure it was effective.
• The practice had limited systems to help them manage risk to patients and staff. There were shortfalls in the assessment and mitigation of risk in relation to recruitment, fire and legionella.
• The five-yearly electrical fixed wire testing had not been undertaken.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Patients were treated with dignity and respect and staff took care to protect their privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked as a team.
• Staff and patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• The provider did not keep records to demonstrate that all staff had received training in safeguarding for vulnerable adults and children or infection prevention and control.
• The provider did not have effective staff recruitment procedures as not all staff had a recent Disclosing and Barring Service (DBS) check or risk assessment at the point of employment and evidence of satisfactory conduct in previous employment (references) were not obtained.
• There was no system to ensure that regular audits of record keeping, and infection control were undertaken at recommended intervals for all clinicians and used to improve the quality of the service.

Background

The provider has 1 practice, and this report is about Bramwell Dental Practice.

Bramwell Dental Practice is in Harpenden and provides NHS and private dental care and treatment for adults and children.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made some adjustments to support patients with additional needs.

The dental team includes 2 dentists, 3 dental nurses, including 2 trainee dental nurses, 2 receptionists and a practice manager. The practice has 2 treatment rooms.

During the inspection we spoke with 1 dentist, 3 dental nurses, 1 receptionist 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 8am to 5pm.

Friday from 8am to 4.30pm.

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.

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

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

• Take action to ensure audits of infection prevention and control, and record keeping are undertaken at regular intervals to improve the quality of the service and that radiography audits have documented learning points and the resulting improvements can be demonstrated.

• Implement an effective system for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.

• Take action to implement all the recommendations in the practice's Legionella risk assessment, 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, maintain records of the flushing of infrequently used water outlets.