Stock Hill Dental Care Partnership

We carried out an announced comprehensive inspection on 7 January 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

Stock Hill Dental Care Partnership is a dental practice located in the London Borough of Bromley. The premises are situated on the ground floor of a converted residential building. There are three treatment rooms, a dedicated decontamination room, an X-ray room, a waiting room with reception area, an administrative office, and a toilet.

The practice provides private services to adults and NHS services to children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges.

The staff structure of the practice consists of three dentists (including the owner), a hygienist, a head dental nurse, two trainee dental nurses and a receptionist.

The practice opening hours are from 9.00am to 5.30pm, Monday to Friday. The practice also opens every other Monday until 7.30pm and is open every other Saturday from 10.00am until 1.00pm.

The principal dentist is the registered manager. A registered manager is a person who is registered with the CQC 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Four people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

• There were effective systems in place to reduce and minimise the risk and spread of infection, although there were some areas where improvements could still be made.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• The provider had a clear vision for the practice and staff told us they were well supported.
• The practice did not have effective safeguarding processes in place and staff had not fully understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Staff recorded accidents, but staff were not aware of systems for reporting or recording incidents or significant events.
• Some equipment, such as the new autoclave (steriliser), and fire extinguishers had been checked for effectiveness and had been regularly serviced; although we noted that records for other equipment, including some of the X-ray machines, were not up to date.
• The practice had not ensured that staff maintained all of the necessary skills and competences needed to support the needs of patients. For example, not all staff were up to date with the training required for responding to medical emergencies.
• The practice had undertaken some relevant checks for the clinical staff at the time of employing them, but not all of the clinical staff had an appropriate Disclosure and Barring Service (DBS) check prior to employment.
• There were governance arrangements in place including a rolling programme for carrying out audits and maintenance to the premises, but these had not effectively identified all of the areas of concern with a view to improving the safety and quality of the service.

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

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure systems and processes are established, and operated effectively, to safeguard vulnerable adults and children with a view to preventing abuse and investigating allegations of abuse.
• Ensure the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure all X-ray equipment is maintained in guidance with the manufacturer’s instructions or governing bodies.

You can see full details of the regulations not being met at the end of this report.

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

• Review the current arrangements and establish a system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the practice’s arrangements for receiving and responding 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 practice’s responsibilities to respond to the needs of disabled people and the requirements of the Equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.
• Review its responsibilities as regards the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use and handling of these substances.
• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.