Bupa Dental Care West Kirby

We carried out an announced comprehensive inspection at Banks House Dental on 30 March 2016 and at this time breaches of legal requirements were found. After the comprehensive inspection the practice wrote to us and told us that they would take action to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 13 HSCA (RA) Regulations 2014 Safeguarding service users from abuse and improper treatment

Regulation 17 HSCA (RA) Regulations 2014 Good Governance

On 18 October 2016 we carried out a focused review of this service under section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The review was carried out to check whether the provider had completed the improvements needed and identified during the comprehensive inspection in March 2016. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Banks House Dental Practice on our website at cqc.org.uk

Background

The practice is situated in West Kirby, Wirral and has waiting areas, a reception area, three treatment rooms, a decontamination room, a staff room/storage area and an administrative office. The practice has three dentists, two hygienists, six qualified dental nurses, a receptionist and a practice manager. The practice provides primary dental services to predominantly NHS patients and some private patients. The practice is open as follows:

Monday 9am – 7pm

Tuesday and Wednesday 8.30am – 5.30pm

Thursday and Friday 9am - 5.30pm

One of the principal dentists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is

run.

CQC inspected the practice on 30 March 2016 and asked the provider to make improvements in relation to:

• Ensuring staff recruitment records contained all the required information to be held relating to staff and with relevance to their role.
• Ensuring a system was implemented by which patient views are analysed, acted on and feedback used to help improve services.
• Ensuring an effective system was established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensuring all staff were trained to an appropriate level for their role in safeguarding of children and protection of vulnerable adults and aware of their responsibilities, including understanding of and responsibilities under the Mental Capacity Act 2005.

We checked these areas as part of this focussed inspection and found these had been resolved.

The findings of this review were as follows:

We found that this practice was now providing safe and well led care in accordance with the relevant regulations.

• All staff working at the practice had a relevant Disclosure and Barring Service (DBS) check undertaken that was appropriate to their role.
• A patient satisfaction survey had been undertaken and findings had been discussed at a practice meeting.
• Identified health and safety risks had now been actioned with controls in place to mitigate the risks.
• Staff had received training in safeguarding at appropriate levels for their role and this included training and awareness of their responsibilities under the Mental Capacity Act 2005
• Staff meetings were organised and documented to include dissemination of governance issues such as dissemination of lessons learnt from significant incidents, events and complaints and sharing improvements from audits and patient feedback.

We found that the practice had acted upon other recommendations made at the previous inspection to improve the service and care. For example:

• The door leading to the local decontamination unit (LDU) was secure and only authorised staff could access it.
• Fire safety training was reviewed and included fire safety/evacuation drills.
• The practice had access to interpreter services for patients who do not speak English as their first language.
• The cleaning schedule has been reviewed and followed National Patient Safety Association (NPSA) guidance on the cleaning of dental premises, including having suitable cleaning equipment in place.

• The training, learning and development needs of staff members had been reviewed and included appraisals at appropriate intervals and ensuring staff were up to date with mandatory training including safeguarding, infection control and fire safety.
• The business continuity plan has been updated, reissued and communicated internally and externally.

We carried out an announced comprehensive inspection on 30 March 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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 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

The practice is situated in West Kirby, Wirral and has waiting areas, reception area, three treatment rooms, a decontamination room, staff room/storage area and an administrative office. The practice has three dentists, two hygienists, six qualified dental nurses, a receptionist and a practice manager. The practice provides primary dental services to predominantly NHS patients and some private patients. The practice is open as follows:

Monday 9am – 7pm

Tuesday and Wednesday 8.30am – 5.30pm

Thursday and Friday 9am - 5.30pm

One of the principal dentists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We received feedback from 13 patients about the service. The five CQC comment cards seen and eight patients spoken to reflected positive comments about the staff and the services provided. Patients commented that the practice appeared clean and tidy and they found the staff very caring, friendly and professional. They had trust and confidence in the dental treatments and said explanations from staff were clear and understandable. They told us appointments usually ran on time and they would recommend the practice.

Our key findings were:

• The practice reported and recorded accidents, significant clinical events and complaints.
• Staff had not received adequate safeguarding or mental capacity act training. There was access to policies and procedures and local authority guidance.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies and emergency medicines and emergency equipment were available.
• Infection prevention and control procedures were in place, however a cleaning schedule was not in place that was monitored and cleaning equipment was not suitable.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and their confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice staff felt valued, involved and worked as a team.
• Clinical staff maintained their own continuous professional development, however there was no clear training plan or appraisal process to ensure all staff were suitably trained in health and safety including fire safety and infection control updates.

• Dentists and some of the dental nurses held clinics in school holidays for the application of fluoride varnish for children. Fluoride varnish application helps to prevent dental decay. Dentists also occasionally visit local primary school to promote good oral health to children.

• There was a lack of a robust governance framework. There was a lack of systems to act on patients’ feedback, monitor and mitigate risks relating to health and safety and maintenance of staff records to include information relevant to their employment within their role.

We identified regulations that were not being met and the provider must:

• Ensure records relating to staff include information relevant to their employment in the role including information relating to the requirements under Regulations 4 to 7 and Regulation19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in particular Disclosure and Barring Service checks relevant to the role.
• Ensure a system is implemented by which patient views are analysed, acted on and feedback used to help improve services.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure all staff are trained to an appropriate level for their role in safeguarding of children and protection of vulnerable adults and aware of their responsibilities, including understanding of and responsibilities under the Mental Capacity Act 2005.

There were areas where the provider could make improvements and should:

• Review the access to the local decontamination unit (LDU).
• Review fire safety training to ensure staff undertake this annually and fire safety drills six monthly.
• Review the availability of an interpreter service for patients who do not speak English as their first language.
• Review the arrangements in place for receiving and recording the response to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the format of staff meetings to include documented dissemination of lessons learnt from significant incidents, events and complaints and sharing improvements from audits and patient feedback.
• Review and document the cleaning schedule to consider following National Patient Safety Association (NPSA) guidance on the cleaning of dental premises, including suitable cleaning equipment.
• Review the training, learning and development needs of staff members at appropriate intervals and establish an effective process for the on-going assessment and supervision of all staff employed which includes ensuring staff are up to date with mandatory training including safeguarding, infection control and fire safety.
• Review the implementation of the business continuity plan so that staff are familiar with its contents and it is accessible.