Fair Green Dental Practice

We undertook a focused inspection of Fair Green Dental Practice on 18 November 2019. 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.

We had undertaken a comprehensive inspection 11 June 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 or well-led care in accordance with the relevant regulations 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 Fair Green Dental Practice on our website www.cqc.org.uk.

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.

As part of this inspection we asked:

• Is it safe
• Is it well-led

Our findings were:

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

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

Background

Fair Green Dental Practice is a well-established service based in Diss and offers NHS general treatment to approximately 16,000 patients. Another provider is located at the same address, and although registered separately, they both operate as one practice, with shared expenses, staff and governance arrangements.

The dental team across both providers consist of two dentists, three dental nurses, and a receptionist. There are two treatment rooms. The practice opens on Mondays to Thursdays from 8.30 am to 5.30 pm, and on Fridays from 8.30 am to 4.30 pm. There is portable ramp access for wheelchair users and parking close by.

The practice is owned by an individual who is the dentist there. He has 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 both dentists, a nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

Key findings

The provider had made sufficient improvements in relation to the regulatory breaches we found at our previous inspection. These must now be embedded in the practice and sustained in the long-term.

We carried out this announced inspection on 11 June 2019 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.

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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

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

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

Fair Green Dental Practice is a well-established service based in Diss and offers NHS general treatment to approximately 16,000 patients. Another provider is located at the same address, and although registered separately, they both operate as one practice, with shared expenses, staff and governance arrangements.

The dental team across both providers consist of two dentists, three dental nurses, and a receptionist. There are two treatment rooms. The practice opens on Mondays to Thursdays from 8.30 am to 5.30 pm, and on Fridays from 8.30 am to 4.30 pm. There is portable ramp access for wheelchair users and parking close by.

The practice is owned by an individual who is the dentist there. He has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 44 CQC comment cards filled in by patients and spoke with another three.

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

Our key findings were:

• Staff treated patients with dignity and respect, and we received many positive comments from patients about the caring and empathetic nature of the dentists.

• The practice was small and friendly, something which both patients and staff appreciated.

• The practice appeared clean and well maintained.

• The appointment system met patients’ needs and patients could get an emergency appointment easily.

• Staff recruitment procedures were not robust and staff had been employed without appropriate checks having been obtained.

• Patient dental care records did not reflect standards set by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• The management of risk in the practice was limited and identified hazards had not been managed adequately.

• The practice’s infection control procedures did not comply with national guidance.

We identified regulations the provider was not meeting. 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.

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:

• Review the practice’s protocols for the use of dental dams for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017.
• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.
• Review staff understanding of the Mental Capacity Act and Gillick competency guidelines so that they are aware of their responsibilities in relation to them.