The Care Quality Commission
  • Dentist
  • Dentist

Mouthmatters

5 York Street, Chester, Cheshire, CH1 3LR (01244) 343353

Provided and run by:
Dr. Gabriele Tschoepe

All Inspections

20 July 2021

During an inspection looking at part of the service

We undertook a follow up desk-based review of Mouthmatters on 20 July 2021. This 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 review was led by a CQC inspector who had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of Mouthmatters on 21 February 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 17, 18 and 19 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 Mouthmatters on our website www.cqc.org.uk.

As part of this review we asked:

• 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. We then inspect or review again after a reasonable interval, focusing on the areas where improvement was required. The provider sent evidence to us of the improvements made in July 2020. The review of the information and evidence submitted was delayed due to CQC processes during COVID-19.

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 21 February 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 21 February 2020.

Background

Mouthmatters is near the centre of Chester. The practice provides private dental care for adults and children. Visiting dentists provide advanced gum disease and root canal treatments, and dental implants at the practice.

The provider has a portable ramp available to facilitate access to the practice for people who use wheelchairs and for people with pushchairs.

Car parking is available near the practice.

The dental team includes two dentists, two dental hygienists and a dental nurse. The dental team is supported by a practice manager. The practice has three 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 review we spoke with the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5.00pm

Our key findings were:

  • Checks were introduced to ensure appropriate medicines and life-saving equipment were available.
  • The practice implemented systems to obtain evidence of up to date training for all staff and maintain oversight of this.
  • Recruitment processes were improved. A checklist was used to ensure essential checks were carried out for new staff members.
  • There were processes for staff to report significant events and incidents.
  • Systems to audit infection prevention and control and radiographic quality were in place.

21/02/2020

During a routine inspection

We carried out this announced inspection on 21 February 2020 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 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 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

Mouthmatters is near the centre of Chester. The practice provides private dental care for adults and children. Visiting dentists provide advanced gum disease and root canal treatments, and dental implants at the practice.

The provider has a portable ramp available to facilitate access to the practice for people who use wheelchairs and for people with pushchairs.

Car parking is available near the practice.

The dental team includes the principal dentist, three visiting dentists, two dental hygienists and two dental nurses. The dental team is supported by a practice manager. The practice has three 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.

We received feedback from 20 people during the inspection about the services provided. The feedback provided was positive.

During the inspection we spoke to the principal dentist, two dental nurses 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 to Friday 8.30am to 5.00pm.

Our key findings were:

  • The practice was visibly clean and well maintained.
  • The practice had infection prevention and control procedures in place.
  • The provider had safeguarding procedures in place.
  • Appropriate medicines and equipment were available. Not all the recommended quality and function checks were carried out on these.
  • The provider had staff recruitment procedures in place. These were not followed when the provider recruited staff.
  • Staff provided patients’ care and treatment in line with current guidelines.
  • The dental team provided preventive care and supported patients to achieve better oral health.
  • The provider did not ensure staff updated their skills in line with current recommendations, including in medical emergencies.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • The appointment system took account of patients’ needs.
  • The provider had a procedure in place for handling complaints. The practice dealt with complaints efficiently.
  • The practice had a leadership and management structure.
  • The provider had systems in place to manage risk.
  • Systems were in place to support the management and delivery of the service, to support governance and to guide staff. Some of these systems were operating ineffectively including the monitoring of training.
  • Staff did not have clear objectives to follow and lacked support for their responsibilities.
  • The practice asked patients and staff for feedback about the services they provided.
  • Changes made as a result of previous inspections were not embedded or sustained. There were limited mechanisms to help the practice continually improve.

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

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Ensure specified information is available regarding each person employed.

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

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This means we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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 taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment. In particular, ensure the local rules are updated.
  • Review the recommendations in the practice's fire safety risk assessment and ensure ongoing fire safety management is effective.
  • Review the practice’s protocols in relation to the use of closed-circuit television to ensure patients are fully informed as to its purpose and their right to access footage.

10/11/2017

During an inspection looking at part of the service

We carried out a follow up inspection on 10 November 2017 at Mouthmatters.

On 30 August 2017 we undertook an announced comprehensive inspection of this service as part of our regulatory functions. During this inspection we found a breach of the legal requirements.

A copy of the report from our comprehensive inspection can be found by selecting the 'all reports' link for Mouthmatters on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements.

We revisited Mouthmatters on 10 November 2017 to confirm whether they had followed their action plan, and to confirm that they now met the legal requirements in the Health and Social Care Act 2008 and associated regulations. We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We reviewed the practice against one of the five questions we ask about services: is the service well-led?

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

Our findings were:

Are services well-led ?

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

Background

Mouthmatters is close to the centre of Chester and provides dental care and treatment to adults and

children on a privately funded basis.

There is a small step at the front entrance to the practice. The provider has a portable ramp available to facilitate access to the practice for wheelchair users. The practice has three treatment rooms. Car parking is available nearby.

The dental team includes a principal dentist, a dental hygienist, two dental nurses, one of whom is also the treatment co-ordinator, and a receptionist. The team is supported by an external practice management consultant. Several specialist dentists provide services at the practice when required.

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 to the principal dentist, one of the dental nurses and the receptionist.

We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5.00pm.

Our key findings were:

  • The practice now had effective systems in place in relation to recruitment, radiation, infection control, and stock control of medicines and dental materials, including medical emergency medicines.
  • The practice had a leadership structure in place. Staff felt involved and worked well as a team.
  • The practice operated robust infection control procedures which reflected published guidance.
  • The practice had improved their systems in place to help them identify and manage risk. Risks associated with fire, used sharps and Legionella had been reasonably reduced.

30/08/2017

During a routine inspection

We carried out this announced inspection on 30 August 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.

We told the NHS England Cheshire and Merseyside area team and Healthwatch that we were inspecting the practice. We did not receive any information of concern from them.

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

Mouthmatters is close to the centre of Chester and provides dental care and treatment to adults and children on a privately funded basis.

There is a small step at the front entrance to the practice. The provider has a portable ramp available to facilitate access to the practice for wheelchair users. The practice has three treatment rooms. Car parking is available near the practice.

The dental team includes a principal dentist, a dental hygienist, two dental nurses, one of whom is the treatment co-ordinator, and a receptionist. The team is supported by an external practice management consultant. Several specialist dentists provide services at the practice when required.

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.

We received feedback from 15 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to the principal dentist, the dental hygienist, one of the dental nurses, the receptionist and the practice management consultant. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5.00pm.

Our key findings were:

  • The practice was clean and well maintained.
  • The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
  • Staff provided patients’ care and treatment in line with current guidelines.
  • The practice had a procedure in place for dealing with complaints.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
  • The practice had a leadership structure. Staff felt involved and supported and worked well as a team.
  • The practice asked patients and staff for feedback about the services they provided.
  • The practice had infection control procedures in place which reflected published guidance, except in relation to re-processing of unused instruments, and storage.
  • Staff knew how to deal with emergencies. Not all the recommended medical emergency medicines and equipment were available.
  • The practice had systems in place to help them manage risk but risks associated with fire, used sharps and Legionella had not all been reasonably reduced.
  • The practice had staff recruitment procedures in place but not all the required information was available in staff recruitment records.

We identified regulations the provider was not meeting. They must:

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

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 and should:

  • Review the practice’s arrangements for responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency and through the Central Alerting System, as well as from other relevant bodies such as, Public Health England.
  • Review the practice’s system for identifying and disposing of out-of-date stock.
  • Review the practice’s protocols and procedures to ensure staff are up to date with their recommended training and their continuing professional development.
  • Review the protocols and procedures in relation to the safe use of X-ray equipment taking account of the relevant guidance notes, specifically in relation to the appointment of a Radiation Protection Adviser and the use of collimation.

5 September 2012

During a routine inspection

We found that people's views and experiences were taken into account and people were given the information they needed to make a decision about their treatment. We spoke to one person who used the service. They told us they were given appropriate information and support regarding their treatment options and costs. They were very positive about the care and treatment they received.

Surveys to find out people's views were undertaken by the service. We looked at sixteen surveys completed in 2011 and 2012. We found that people were happy with the service being provided. All considered that staff were friendly and helpful and that procedures and costs were explained. We found that clear records were maintained of people's medical history and treatment plans. There was a clear system for patient re-call. This ensured that people's health care needs were appropriately supported.

Staff had received guidance in safeguarding the welfare of children and vulnerable adults. This showed that the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that people were protected from the risk of infection because appropriate guidance was being followed. A person who used the service and the results from surveys indicated that the service was clean.

We found that there were systems in place to monitor the quality of the service provided. This ensured that people benefitted from a safe and effective service.