Archived: Haughton Green Dental Practice

We undertook a follow-up desk-based inspection of Haughton Green Dental Practice on 19 February 2020. 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.

We undertook a comprehensive inspection of Haughton Green Dental Practice on 19 November 2020 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 safe or well led care and was in breach of regulations 12 and 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 Haughton Green Dental Practice on our website www.cqc.org.uk.

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

• Is it safe?

• 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.

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 19 November 2020.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 19 November 2020.

Background

Haughton Green Dental Practice is in Denton, Manchester and provides NHS care and treatment for adults and children.

The practice is not suitable for those patients who use wheelchairs due to the dental treatment rooms being located on the first floor, which is accessed via a staircase. The practice is accessible at ground floor level for those with pushchairs. Car parking spaces are available at the rear of the practice.

The dental team includes three dentists, four dental nurses, two of whom are trainees, one dental hygiene therapist and a practice receptionist. The practice is supported by a practice manager and 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.

During the inspection we spoke with the principal dentist and the practice manager. Documentation was provided by the practice, in support of and to confirm the improvements made.

Our key findings were:

• Infection control processes and management of these had improved.
• All staff had received further training in the processes for decontamination of dental instruments in accordance with recognised guidance and good practice.
• Infection control audits were in place and were scheduled to take place every six months.
• All recommended emergency medicines and equipment was available for use.
• A Legionella risk assessment had been carried out by a competent person.
• Essential safety checks in relation to the premises were now in place. A gas and electrical safety check had been carried out and documents were in place to confirm that fixed wiring and gas appliances were safe.
• Reception staff had received sepsis awareness training.
• Systems and processes to support good governance had been improved.
• A system had been introduced to ensure all staff had read, discussed and understood any patient safety alerts and clinical practice updates.
• Audit of patient record cards was in place; antibiotic audits were carried out weekly to check prescribing remained within current guidelines.
• Radiography audits were carried out monthly.
• An effective system of recording significant events was in place.
• The provider had updated their registration with the Care Quality Commission, confirming that the practice carried out surgical procedures.

We carried out this announced inspection on 19 November 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 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:

Are services safe?

We found this practice was not 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

Haughton Green Dental Practice is based in Denton, Manchester, Greater Manchester and provides NHS care and treatment for adults and children.

The practice is not suitable for those patients who use wheelchairs due to the dental treatment rooms being located on the first floor, which is accessed via a staircase. The practice is accessible at ground floor level for those with pushchairs. Car parking spaces are available at the rear of the practice.

The dental team includes three dentists, four dental nurses, two of whom are trainees, one dental hygiene therapist and a practice receptionist. The practice is supported by a practice manager and 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 36 CQC comment cards filled in by patients. All views expressed were positive.

During the inspection we spoke with the principal dentist, two dental nurses, the dental hygiene therapist 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 and Thursday from 9am to 5pm; Tuesday and Wednesday from 8.30am to 4pm, and on Friday from 8.30am to 4pm.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had some infection control procedures which reflected published guidance. Guidance in relation to the processing of dental instruments was not always adhered to.
• Staff knew how to deal with emergencies.
• Not all appropriate life-saving equipment was available as described in recognised guidance.
• The provider had systems to help them manage risk to patients and staff. Some of these required review and advice from suitably qualified persons.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures which reflected current legislation.
• Some care and treatment provided to patients was not in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health. We found some care and treatment provided was not in line with recognised guidance.
• The appointment system took account of patients’ needs.
• Clinical leadership was present and recognisable. More use of audit and peer review was required to support a culture of continuous improvement.
• Staff felt involved and supported and worked as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with any complaints positively and efficiently.
• The provider had information governance arrangements.

We identified regulations the provider was not complying with. They must:

Ensure care and treatment is provided in a safe way to patients.

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

Full details of the regulations the provider is not meeting are at the end of this report.

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

Take action to ensure dentists are aware of the guidelines issued by the British Endodontic Society for the use of dental dam for root canal treatment.

Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.