Archived: The Clock Dental Practice

We saw improvements had been made to the providers quality assurance processes. Clinical risk assessments such as treatment and radiology had been reviewed and completed. A clear complaints process had been put in place and was displayed in the waiting room for patients to follow should they require it. The control of substances hazardous to health policy (COSHH) now referred to the correct 2002 COSHH regulations. Additionally the practice now had a patient brochure which clearly explained the services available to them and their costs.

Care and treatment of patients was based upon a full mouth assessment which identified the problem and the appropriate course of treatment the patient required. Facilities were in place to manage medical emergencies with emergency equipment and medicines prepared in a simple and accessible way. The patients we spoke with were complementary about the care and treatment provided. One person told us, 'The staff are friendly and helpful.' Whilst another person said, 'I'm given good information, advice and choices'.

The provider had cleanliness and infection control systems in place to prevent, detect and control the spread of a health care associated infection. All surgeries, public areas and the waiting area were clean and tidy. Staff carried out appropriate hygiene and infection control procedures, wore personal protective equipment (PPE) when they provided patient care and made PPE available to patients for their protection. Audits and checks were in place which ensured all aspects of cleanliness and infection control were routinely monitored.

The public and surgical areas of the practice were appropriately maintained and fit for purpose and arrangements had been made to ensure fire prevention and alerting were now in place. Previously unsecured areas were now restricted to staff and unused surgeries were locked.

There was sufficient equipment available to the surgeries in use and a dedicated equipment decontamination room had been established. A technician was employed to ensure all dental equipment was cleaned effectively to current guidance standards.

There were effective recruitment processes in place. Staff were checked by the Disclosure and Barring Service, references were gained and identification was checked to ensure they had a legal right to work in this country. All the dental practitioners and the dental hygienist were General Dental Council (GDC) registered. Staff had access to support, training and development which enhanced their skills in relation to their role.

Audits were in place for many aspects of the service however some areas of the auditing required improvement. For example; making information about complaints available to patients; reviewing policies to ensure up to date guidance was included; responding to patient feedback and auditing the quality of equipment in surgeries not used by dentists.

Records relating to the care of patients and the management of the service were managed appropriately. Medical and medication records were routinely checked before the patient received treatments. The provider carried out routine clinical audits of records to ensure recording met the standards required by the provider and the GDC. Patients could be reassured that their information was stored securely and accessed easily if required.

We had arranged with the provider that we would revisit the practice on 5 June 2013. On the day of the inspection the provider was not present as they told us they were attending a training course. The provider had appointed a trainee dental nurse to liaise with us during this time. The dental nurse told us the provider had left all the paperwork we had requested.

We found the systems in place to monitor safe recruitment of staff, infection control and managing emergency medicines and equipment had not changed since our initial inspection in March 2013. We found improvements had been made when we followed up on these areas of non-compliance in May 2013. However, non-compliance was still found at the May inspection for infection control and the safe recruitment of workers. The provider could not assure us that these systems were effective to ensure people's health and safety was protected at all times.

We also looked at other areas of how the provider assessed and monitored the service. We found that some of these systems could be improved to ensure potential risks to people's health and safety were minimised.

We found that the provider had improved significantly with how they managed their medicines in particular emergency medicines. We found infection control practices and recruitment arrangements had improved significantly reducing the risks to people using the service. However, the provider still needed to make further improvements to ensure they were compliant with our regulations.

We spoke with seven people using the service. People told us they were generally happy with the service provided. One person said '10 out of 10, it's easy to get to and they treat you how you want to be treated'. Other people made comments that they saw different dentists and receptionists each time they visited. They said this meant it could sometimes be difficult to receive consistent communication of their treatment options.

We did not speak with people who used the service on this occasion. We spoke with six members of the dental team including the provider, two dental nurses, the decontamination technician, the receptionist and the cleaner. The other dentist working in the practice was unavailable to speak with us.

We found a number of significant concerns during our inspection. These were in relation to poor infection control practices and how medicines were managed including medicines used in an emergency. There were inadequate procedures for the recruitment of new staff and how staff were trained to ensure they had the necessary skills and qualifications to carry out their role. People's records were not kept secure. The provider had not identified risks to people's health, welfare and safety. They also did not have effective systems in place to assess and monitor the service provided.