Butt Lane Dental Surgery

We undertook a follow up desk-based inspection of Butt Lane Dental Practice on 23 October 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.

The inspection was led by a CQC inspector who had access to remote advice from a specialist dental adviser.

We undertook a comprehensive inspection of Butt Lane Dental Practice on 11 February 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 well led care and was in breach of regulation 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 Butt Lane dental practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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 (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

Our findings were:

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 breach we found at our inspection on 11 February 2019.

Background

Butt Lane dental practice is in Talke, Stoke on Trent and provides NHS and private treatment for adults and children.

A portable ramp is available to provide access for people who use wheelchairs and those with pushchairs. Car parking spaces are available on the road at the front of the practice and on side roads near the practice. There is a car park within a short walk of the practice.

The dental team includes two dentists, five dental nurses, two dental hygiene therapists, a cleaner, an administration assistant and a receptionist. The practice has three treatment rooms.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Butt Lane dental practice is the principal dentist.

During the inspection we checked that the registered provider’s action plan had been implemented. We reviewed a range of documents provided by the registered provider.

The practice is open: Monday and Tuesday 11am to 2pm and 3pm to 7pm. Wednesday 8.15am to 12.15pm and 1.30pm to 4.15pm. Thursday and Friday 9am to 1pm and 2pm to 5pm.

Our key findings were:

The registered person had implemented a sharps risk assessment.

The provider confirmed that risk assessments had been completed for each hazardous substance in use at the practice.

The provider had completed an infection prevention and control audit and highlighted issues for action; subsequent action had been taken to address the issues.

The practice had completed an audit regarding antibiotic prescribing.

The registered person had developed a sepsis protocol which included information to enable assessment of patients with presumed sepsis in line with National institute of Health and Care Excellence guidance.

The registered person had introduced a proforma to ensure that dental care records were completed taking into account the guidance provided by the Faculty of General Dental Practice.

The practice had developed a protocol for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

Staff had completed training regarding the requirements of the Mental Capacity Act 2005.

Cloth covered seating in dental treatment rooms and carpet on flooring had been replaced to help maintain high standards of cleanliness and infection control.

We carried out this announced inspection on Monday 11 February 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 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

Butt Lane Dental Surgery is in Talke, Stoke on Trent and provides NHS and private treatment to adults and children.

A portable ramp is available to provide access for people who use wheelchairs and those with pushchairs. Car parking spaces are available on the road at the front of the practice and on side roads near the practice. There is a car park within a short walk of the practice.

The dental team includes two dentists, five dental nurses, two dental hygiene therapists, a cleaner, an administration assistant and a receptionist. The practice has three treatment rooms.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Butt Lane Dental Practice is the principal dentist.

On the day of inspection, we received feedback from 33 patients.

During the inspection we spoke with the principal dentist, four dental nurses, one dental hygiene therapist and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday and Tuesday 11am to 2pm and 3pm to 7pm. Wednesday 8.15am to 12.15pm and 1.30pm to 4.15pm. Thursday and Friday 9am to 1pm and 2pm to 5pm.

Our key findings were:

• We received positive feedback from patients about the staff and the dental care they received at the practice.
• The practice appeared visibly clean and well maintained. We noted that the practice did not have all of the appropriate cleaning equipment required.
• The provider had infection control procedures which reflected published guidance.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.

• The practice had systems to help them manage risk to patients and staff. Some risk assessments completed by external professionals had passed their expiry date. A further risk assessment was completed following this inspection.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• Quality assurance systems such as clinical audit required improvement. The infection prevention and control audit did not have any learning outcomes or actions recorded. Practice meeting minutes recorded brief details of discussions held regarding audits.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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.

Full details of the regulation the provider is 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 rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular review the provision of cloth seating and carpeted areas in dental treatment rooms.