Archived: Abbey Dental Walthamstow

We undertook a follow up focused inspection of Abbey Dental Walthamstow on 6 June 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 Abbey Dental Walthamstow on 6 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 safe and well led care and was in breach of Regulation 12 - Safe care and treatment,

Regulation 15 - Premises and Equipment and

Regulation 17 – Good governance 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 Abbey Dental Walthamstow on our website www.cqc.org.uk.

• Is it safe?

• 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 again after a reasonable interval, focusing on the areas where improvement was required.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations. The provider had made improvements in relation to the regulatory breach we found at our inspection on 6 February 2019.

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 6 February 2019.

Background

Abbey Dental Walthamstow is in the London Borough of Waltham Forest. The practice provides NHS and private treatment to patients of all ages.

The practice is located on the ground floor of the premises. The layout and design of the building does not offer step free access. The practice is located close to public transport routes including bus and train services.

The dental team includes seven associate dentists, one dental hygienist and six dental nurses. The clinical team are supported by a practice manager and two receptionists.

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 Abbey Dental Walthamstow was the practice manager.

During the inspection we spoke with one associate dentist, the practice manager and one dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 8am and 6pm on Mondays, Tuesdays and Wednesdays, between 8am and 5pm on Thursdays and between 8am and 4pm on Fridays.

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Our key findings were:

• Improvements had been made so that so that the practice premises and equipment were maintained suitably and fit for use.

• The practice had infection control procedures which reflected published guidance and there were arrangements for minimising the risks associated with Legionella.

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

• The practice had systems to help them manage risk. Improvements had been made so that the risks associate with fire were minimised.

• The practice had made improvements to its leadership. Staff felt more confident that they could raise concerns and that these would be listened to and addressed.

• There were processes in place to ensure the on-going supervision and appraisal for staff.

• There were arrangements to assess and minimise risks where the dental hygienist worked without chairside support.

We carried out this unannounced inspection on 6 February 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to follow up on concerns we received and 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 Care Quality Commission 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 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

Abbey Dental Walthamstow is in the London Borough of Waltham Forest. The practice provides NHS and private treatment to patients of all ages.

The practice is located on the ground floor of the premises. The layout and design of the building does not offer step free access. The practice is located close to public transport routes including bus and train services.

The dental team includes seven associate dentists, one dental hygienist and six dental nurses. The clinical team are supported by a practice manager and three receptionists.

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 Abbey Dental Walthamstow was the practice manager.

During the inspection we spoke with one associate dentist, the practice manager, three dental nurses and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 8am and 6pm on Mondays, Tuesdays and Wednesdays, between 8am and 5pm on Thursdays and between 8am and 4pm on Fridays.

Our key findings were:

• The practice 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had arrangements to deal with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The practice asked patients for feedback about the services they provided
• Some areas of the practice were not clean or fit for use.
• The practice had infection control procedures which reflected published guidance. Improvements were needed to the arrangements for minimising the risks associated with Legionella.
• Staff knew how to deal with emergencies. Improvements were needed so that the recommended emergency medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. Improvements were needed so that the risks associate with fire were minimised.
• The practice did not have effective leadership. Staff told us that did not feel involved or confident that when they raised issues these would be taken seriously and acted on.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients.

• Ensure all premises and equipment used by the service provider is fit for use and maintain appropriate standards of hygiene for premises and equipment.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

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

• Review availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. This relates specifically to the use of rectangular collimators.
• 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. This relates specifically to assessing and minimising the risks when the dental hygienist works without chairside support.

Following our inspection the dental provider sent us details of the actions they were taking to make the required improvements. We will review these when we carry out a focused inspection in line with our methodology.