We carried out this announced inspection on 13 June 2017 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
Berry Lane Dental Clinic is in Rickmansworth, Hertfordshire and provides NHS and private treatment to patients of all ages. We were informed that shortly following the inspection the practice was contracted to provide out of hours treatment to patients in need via the NHS 111 service.
There is access for people who use wheelchairs and pushchairs via a ramp to a ground floor treatment room. Car parking spaces are available in front of the practice with further street parking nearby.
The dental team includes five dentists, five dental nurses of whom two were in training, two dental hygienist therapists and a practice manager. Both the practice manager and two dental nurses also work as receptionists. The practice has two 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 eight CQC comment cards filled in by patients and spoke with one other patient. This information gave us a positive view of the practice.
During the inspection we spoke with one dentist, two dental nurses, one dental hygiene therapist, one 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 from 8 am to 5 pm and Tuesday to Friday from 9 am to 5pm. We were informed that shortly following the inspection the practice was extending its opening hours to accommodate the out of hours’ service. This meant that the practice would be open Monday to Friday from 6 pm to 8 pm and Saturday and Sunday from 10 am to 6 pm in addition to the hours stated above.
Our key findings were:
- The practice was clean and mostly well maintained.
- The practice had infection control procedures which did not fully reflect 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. Certain risk assessments had not been conducted at the time of the inspection.
- The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- The practice carried out staff recruitment procedures, although references were not always documented and a DBS check had not been completed for one member of staff.
- 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.
- The appointment system met patients’ needs.
- Staff felt involved and supported and worked well as a team.
- The practice asked staff and patients for feedback about the services they provided.
- The practice dealt with complaints positively and efficiently.
- Clinical audit was not effective as a tool to highlight areas of improvement in respect of infection prevention and control.
We identified regulations the provider was not meeting. They must:
- Ensure effective systems are in place in order that the regulated activities at Berry Lane Dental Clinic are compliant with the requirements of Regulations 4 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example systems to assess, monitor and mitigate risks and systems to assess, monitor and improve the quality and safety of the services provided.
Full details of the regulations the provider was not meeting are at the end of this report.
There were areas where the provider could make improvements. They should:
- Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
- Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
- Review practice's recruitment procedures to ensure that appropriate background checks are completed prior to new staff commencing employment at the practice.
- Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
- Review availability of an interpreter services for patients who do not speak English as a first language.