Archived: T & T Dental

We undertook a follow up focused inspection of T&T Dental on 23 January 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 who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of T&T Dental on 30 August 2019 and 9 September 2019 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, effective or well-led care and was in breach of regulations 9, 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 T&T Dental on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it effective?

• 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.

Our findings were:

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 30 August 2019 and 9 September 2019.

Are services effective?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 30 August 2019 and 9 September 2019.

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 30 August 2019 and 9 September 2019.

Background

T&T Dental is in the Walton area of Liverpool and provides NHS and private dental treatment to adults and children.

The dental team includes both dentists and five dental nurses (including two trainees) who also have administrative and reception duties. The practice has two treatment rooms and an instrument decontamination room. One of the treatment rooms is located on the ground floor. There is ramped access into the practice for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice on local roads.

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 two dentists and one dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Wednesday: from 9am to 5.30pm and Thursday and Friday: from 9am to 5pm

Our key findings were:

• The provider had taken action to ensure the risks associated with the use of non-encapsulated mercury had been removed from the practice.
• The security of NHS prescription pads held and used at the practice had been improved.
• Fire safety had been improved with fire marshal training booked for key staff, an updated fire risk assessment and six-monthly fire drills implemented for all staff.
• A five-year fixed wire electrical safety certificate had been issued in October 2019.
• The provider had introduced single use, disposable matrix bands to eliminate the risk of injury from this equipment.
• The manual cleaning process for dental instruments had been reviewed. Records were in place to support compliance with protocols for manual cleaning of dental instruments.
• The provider had replaced the rusty spittoon in the downstairs treatment room, had the work surface repaired and the dental chair had been recovered.
• All chemical products within the practice had an individual risk assessment and an attendant product safety data sheet.
• Staff training records showed all staff were up to date with their safeguarding training, and to the required level.
• The provider had reviewed the system of audits within the practice.
• Records showed that radiographs were being justified and graded.
• A new duty of candour policy had been produced and all staff had received training about the duty of candour in November 2019.
• The consent policy had been reviewed.
• The Legionella risk assessment had been reviewed, and a new risk assessment was due for completion by an external contractor.
• Staff had completed training on the essentials of Legionella in January 2020.
• The use of dental dams in the practice had been reviewed.
• The provider had reviewed the dental care records and introduced a traffic light system for highlighting risk.
• Antibiotic prescribing had been reviewed.

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

• 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 with regard to the use of rectangular collimation.

We carried out this unannounced inspection on 30 August 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We returned on 9 September 2019 to complete the inspection, this second visit was announced. 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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

T&T Dental is in the Walton area of Liverpool and provides NHS and private dental treatment to adults and children.

The dental team includes two dentists and five dental nurses (including two trainees) who also have administrative and reception duties. The practice has two treatment rooms and an instrument decontamination room. One of the treatment rooms is located on the ground floor. There is ramped access into the practice for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice on local roads.

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.

Throughout the inspection, we collected 25 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists and three dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Wednesday: from 9am to 5.30pm

Thursday and Friday: from 9am to 5pm

Our key findings were:

• The practice appeared clean.
• Infection control procedures were not in line with published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The systems to help them manage risk to patients and staff were not robust and required improvement.
• The use of amalgam was not in accordance with European Union Regulation 2017/852 for the use of mercury.
• Risk assessments had not been completed in line with the Control of Substances Hazardous to Health Regulations 2002.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. However, staff training was overdue.
• The provider had followed their staff recruitment procedures.
• The clinical staff had not always provided patients’ care and treatment in line with current guidelines. There was evidence of single use items being reused.

• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider could not demonstrate that regular fire drills were being held, or that staff were up-to-date with fire training.

• NHS prescriptions were not monitored or kept securely.
• Checks to ensure risks were mitigated in respect of Legionella had not been recorded.
• The appointment system took account of patients’ needs.
• The provider did not have robust systems and processes to ask staff and patients for feedback about the services they provided.
• Policies and procedures were in need of review.
• The provider’s systems for quality improvement were not robust.
• The provider had suitable 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.

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

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:

• 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 with regard to the use of rectangular collimation.

• Improve the practice's systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular through the use of dental dams when completing endodontic treatments in line with guidance from the British Endodontic Society.