Updated 17 April 2019
We undertook this follow-up focused inspection on 28 February 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 Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.
We previously undertook a comprehensive inspection on 23 and 25 July 2018 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, effective or well led care and was in breach of Regulations 12, 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 Confidental Care on our website www.cqc.org.uk.
As part of this inspection we asked:
• Is it safe?
• Is it effective?
• 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. We then inspect the service again after a reasonable interval, focusing on the areas where improvement was required.
Our findings during this inspection were:
Are services safe?
We found this practice was providing safe care in accordance with the relevant regulations.
The provider had made several improvements in relation to the regulatory breach we found during the previous inspection on 23 and 25 July 2018.
Are services effective?
We found this practice was providing effective care in accordance with the relevant regulations.
The provider had made improvements in relation to the regulatory breach we found at our inspection on 23 and 25 July 2018.
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 23 and 25 July 2018.
Background
Confidental Care is in the London Borough of Bromley and provides NHS and private treatment to patients of all ages.
The dental team includes three dentists, two qualified dental nurses (one of whom is a locum), a trainee dental nurse, three decontamination assistants (two of whom also undertake receptionist duties), and a receptionist. The provider had employed the services of a compliance adviser to assist them in implementing the necessary improvements.
The practice has five 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 inspection we spoke with two dentists, a compliance advisor, three dental nurses, a receptionist, and the practice administrator. We checked practice policies and procedures and other records about how the service is managed.
The practice is open at the following times:
Mondays to Thursdays – 9am to 6pm
Fridays – 9am to 5pm
Every other Saturday – 9am to 1pm
Our key findings were:
- The provider had established a system for identifying, receiving, recording, handling and responding to complaints by service users.
- The provider had implemented an effective system to ensure all referrals could be monitored suitably.
- Risks related to fire safety, electrical safety, health and safety, significant events, Legionella prevention, the security of prescription pads, infection prevention and control processes had been reviewed and mitigated.
- The provider had checked that clinical staff had achieved a satisfactory level of immunity against Hepatitis B.
- Prescription pads were stored securely.
- There was sufficient equipment used to manage medical emergencies, and these had been suitably maintained and monitored.
- The provider had improved arrangements for monitoring medicines and dental materials to ensure they remained in date and fit for use.
- The provider had implemented suitable up-to-date policies to provide guidance to staff.
- The provider had not carried out audits to monitor the quality of safety of the practice’s clinical systems and processes.
- The provider had made key safety improvements relating to the provision of dental treatment using conscious sedation. However, because the provider had not met all of the requirements of the conditions we had imposed upon their registration with the CQC in July 2018, we took the decision to continue the enforcement action to prevent them from providing dental treatments under conscious sedation until they have made the necessary improvements.
- The provider had improved their recruitment procedure to ensure key background checks were carried out for new staff, and they maintained up-to-date records relating to professional registrations and indemnity insurance for clinical staff.
- Staff had received appraisals, and they had completed key training and continuing professional development. The provider had implemented a system to monitor training needs of their staff.
- Staff reported that communication and morale had improved, and that there was more cohesive working amongst staff. They demonstrated a good understanding of governance arrangements and requirements.
- Dental care records were stored securely. Most dental care records were well-written but some lacked key information.
- Rubber dam was still not being used consistently or its non-use suitably risk assessed and documented by all dentists for root canal treatments.
There were areas where the provider could make improvements. They should:
- Review the practice's protocols for completion of dental care records, taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
- 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.