Archived: Tooth Booth Needham Market

We carried out this announced inspection to follow up a Warning Notice served to the providers on 29 September 2017, as they were failing to comply with Regulation 17, (1), Good governance, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the previous comprehensive inspection on the 17 January 2017, we found the registered provider was providing effective, caring and responsive care in accordance with relevant regulations. However, we judged the practice was not providing safe or well-led care in accordance with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We conducted a focussed inspection on 25 September 2017, and although we noted improvements in how safe the practice was, we found the provider had made insufficient improvements to address the shortfalls we had identified in how the practice was governed.

You can read our previous report of that inspection by selecting the 'all reports' link for Tooth Booth Needham Market on our website www.cqc.org.uk.

During the inspection we spoke with one of the owners and the practice manager. We checked the decontamination room and viewed a range of paperwork in relation to the management of the practice.

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 sufficient improvements to put right the shortfalls we found at our inspections on the 17 January and 25 September 2017. The provider must now ensure that the newly implemented improvements are embedded and sustained in the long- term in the practice.

We carried out a focused inspection of Tooth Booth-Needham Market on 25 September 2017.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 17 January 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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 area where improvement was required.

At the previous comprehensive inspection, we found the registered provider was providing effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing safe or well-led care in accordance with 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 Tooth Booth Needham Market on our website www.cqc.org.uk.

Our findings were:

Are services safe?

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

The provider had made improvements to put right some of the shortfalls we found at our inspection on 17 January 2017, although had failed to address a number of others.

Are services well-led?

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

The provider had made insufficient improvements to put right the shortfalls and had not dealt with the regulatory breach we found at our inspection on 17 January 2017.

We carried out an announced comprehensive inspection on 17 January 2017 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

Tooth Booth-Needham Market is one of eight practices owned by Tooth Booth Group Limited. It was established in 2011and provides mostly NHS services to about 6000 patients. In addition to general dental services, it provides domiciliary dental services to about 3000 patients across mid Suffolk.

The team consists of two permanent dentists (both of whom undertake the domiciliary work), two permanent nurses, a practice manager and a receptionist. They are supported by three additional part-time locum dentists and two locum nurses.

The practice opens from 8.30am to 6pmon Mondays, Wednesdays and Fridays; from 8.30am to 8pm on a Tuesday and Thursday, and on Saturdays from 8.30 am to1pm. The domiciliary service operates from 9am to 5pm Monday to Fridays.

One of the practice’s owners is registered with the Care Quality Commission 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.

Before the inspection we sent comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 10 patients via the cards and spoke with two patients during our inspection.

Our key findings were:

• The practice offered extensive opening hours both during the week, at weekends and patients were able to access appointments at times that suited them. Emergency slots were available each day for patients requiring urgent treatment.
• Patients received clear explanations about their proposed treatment and were actively involved in making decisions about it. They were treated in a way that they liked by staff.
• Staff had received safeguarding training and took good action to protect vulnerable patients when needed.
• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.
• The practice relied heavily on locum dentists and nurses to ensure the service could be provided.

• The practice’s sharps handling procedures and protocols were not in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Some of the practice’s infection control procedures and protocols did not meet 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’.

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

• Ensure effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and national guidance relevant to dental practice. This includes the recording of untoward events, the management of sharps, the recruitment of staff and the control of infection.

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

• Carry a TREM card (traffic emergency card) in vehicles when transporting oxygen cylinders.

• Review the systems for monitoring and tracking prescription pads in the practice

• Review the storage of dental care records to ensure they are held securely.