Framlingham Dental Practice

We undertook a follow up focused inspection of Framlingham Dental Practice on 22 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 was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Framlingham Dental Practice on 20 May 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 regulations 12 and 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 Framlingham Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

If applicable

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 breaches we found at our inspection on 20 May 2019.

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

Background

Framlingham Dental Practice is in Framlingham and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in car parks near the practice.

The dental team includes three dentists, two dental nurses and one trainee dental nurse, two hygienists and the reception manager. The practice has four treatment rooms, one room is currently not in use.

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 with one dental hygienist and the reception manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 8.30am to 5.30pm. The practice opens from 8am on Tuesday mornings. Thursday evening appointments are available by appointment.

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had systems to help them manage risk to patients and staff. In particular we noted recommendations from the legionella risk assessment had been actioned.
• The practice had suitable arrangements to ensure the safety of the X-ray equipment and we saw the required information was in their radiation protection file.
• Audits systems had been reviewed with audits of radiography, dental records and infection prevention and control undertaken to improve the quality of the service. There was scope to ensure audits of antimicrobial audits were undertaken.
• Due to glass panels in three of the four treatment room doors we noted patients could be seen in dental chairs receiving treatment when other patients or visitors to the practice were walking up the stairs and along corridors.

There were areas where the provider could make improvements. They should:

• Introduce protocols regarding the prescribing of antibiotic medicines.

We carried out this announced inspection on 20 May 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

Framlingham Dental Practice is in Framlingham and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in car parks near the practice.

The dental team includes three dentists, three dental nurses and one trainee dental nurse, and the reception manager. The practice has four treatment rooms, one room is currently not in use.

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 Framlingham Dental Practice was the principal dentist.

On the day of inspection, we collected 34 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two dental nurses, one dental hygienist, one receptionist and the reception manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 8.30am to 5.30pm. The practice opens from 8am on Tuesday mornings. Thursday evening appointments are available by appointment.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The practice appeared clean and well maintained. A five-year fixed wire test had not been completed.
• The practice staff had infection control procedures which reflected published guidance. We found the practice did not have records of six-monthly infection control audits.
• Appropriate medicines and some life-saving equipment were available. The practice was missing some essential medical emergency equipment such as the required clear face masks and ambu bags. Staff Basic Life Support (BLS) training was overdue.
• The practice had some systems to help them manage risk. However, risk assessments were limited.
• A legionella risk assessment had been undertaken. There was limited evidence that any recommended actions had been reviewed and completed.
• There was limited evidence that any recommended actions from the most recent radiation surveys had been reviewed or completed. The X-ray annual mechanical electrical checks had not been undertaken.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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 regulation/s the provider was/is not meeting are at the end of this report.

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There were areas where the provider could make improvements. They should:

• Assess any potential risks of staff lone working in the practice and implement suitable control measures to minimise them.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.

• Introduce protocols regarding the prescribing of antibiotic medicines and review the practice's protocols for the security of NHS prescription pads in the practice.