Updated 13 December 2022
We carried out this announced comprehensive inspection on 8 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 advisor.
To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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 reflected published guidance.
- The practice had systems to help them manage risk to patients and staff.
- Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
- 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.
- There was effective leadership and a culture of continuous improvement.
- 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 dental clinic had information governance arrangements.
- Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available. Improvements were needed to the practice`s monitoring system to ensure out of date medical emergency equipment was suitably identified and replaced.
- The practice had staff recruitment procedures which broadly reflected current legislation. Improvements were needed to ensure that evidence of conduct in previous employment were obtained at the point of employment.
- Improvements were needed to the practice`s monitoring system of continuing professional development to ensure clinical staff were up to date with their mandatory training and continuing professional development.
Background
Deansbrook Care Centre is in the London Borough of Barnet 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 are available near the practice. The practice has made reasonable adjustments to support patients with additional needs by ensuring there was an accessible toilet.
The dental team includes 6 dentists, 4 qualified dental nurses, 2 trainee dental nurses, 3 dental hygienists and 2 receptionists. They are supported by a practice manager. The practice has 5 treatment rooms.
During the inspection we spoke with 1 dentist, 1 trainee dental nurse, 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 Friday 9am to 6pm.
There were areas where the provider could make improvements. They should:
- Improve the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained. In particular, ensure that the checking system is effective to identify out of date medical emergency equipment.
- Implement an effective recruitment procedure to ensure that appropriate checks are completed prior to new staff commencing employment at the practice. In particular, ensure that evidence of conduct in previous employment is obtained at the point of employment.
- Implement practice protocols and procedures to ensure staff are up to date with their mandatory training and their continuing professional development.
- Improve 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. In particular, ensure that rectangular collimators are used with the intraoral X-ray units.