We undertook a focused inspection of B74 Dental Practice on 5 October 2021. 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 B74 Dental Practice on 8 June 2021 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 or well led care and was in breach of regulation 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 B74 Dental Practice on our website www.cqc.org.uk.
As part of this inspection we asked:
• 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 (requirement notice only). We then inspect again after a reasonable interval, focusing on the areas where improvement was required.
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 in relation to the regulatory breaches we found at our inspection on 8 June 2021.
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 responded to the regulatory breach we found at our inspection on 8 June 2021.
Background
B74 Dental is in Streetly, Sutton Coldfield and provides private dental care and treatment for adults and children.
There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the front of the practice.
The dental team includes one dentist (the provider) and one dental nurse who also works on reception. The practice has one treatment room.
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 dentist (the provider). We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday - closed
Tuesday 9am – 1pm, 2pm – 5.30pm
Wednesday – by appointment
Thursday - closed
Friday 9am – 1pm, 2pm – 5.30pm
Saturday – by appointment
Sunday - closed
Our key findings were:
- Staff had completed training, to an appropriate level, in the safeguarding of vulnerable adults and children.
- The provider had sufficient amounts of in date medical oxygen, adrenaline and other equipment to respond to a medical emergency.
- Sepsis oversight and management was established.
- The provider had effective oversight and was aware of the current guidance with regards to prescribing medicines
- Further action was required to ensure that appropriate information was recorded on dispensing labels.
- A stock control system had been introduced for medicines held on the premises.
- Improvements were required to the system for recording, investigating and reviewing incidents or significant events.
- Systems for checking medical emergency equipment did not ensure that these were checked at the required frequency.
- Staff had completed training in the management of medical emergencies.
- The provider had effective oversight ensuring all clinical waste was removed safely.
- Evidence was not available to demonstrate that the provider had taken action to implement all recommendations in the practice's Legionella risk assessment.
- Infection prevention and control audits were not undertaken at regular intervals.
- The provider had actioned the majority of recommendations from the previous fire risk assessment. One issue remained outstanding.
- A five-year fixed wiring test was carried out in June 2021.
- A centrally monitored system had been implemented to ensure patient referrals to other dental or health care professionals were received in a timely manner and not lost.
- A system had been implemented for receiving and responding to patient safety alerts, recalls and rapid response reports.
- There was a sharps risk assessment but this did not include details of all sharp objects in use at the practice.
- Further action should be taken to develop a system for the on-going assessment, supervision and appraisal of staff.
- Policies and procedures had been reviewed on an annual basis or as needed if updates were required.
- Action has been taken to ensure the clinician takes into account guidance provided by the Faculty of General Dental Practice when completing dental care records and guidance on the Safe use of X-ray Equipment or HP-CRCE-010. the reason for taking X-rays, a report on the findings and the quality of the image is being recorded in the patients’ dental care records or elsewhere in compliance with Ionising Radiation (Medical Exposure) Regulations 2017.
- Some further improvements are required to the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.
- Audits had been scheduled for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice, but these had not yet been completed.
We identified regulations the provider was not meeting. 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:
- Improve the practice's protocols for medicines management and ensure all medicines are stored and dispensed of safely and securely.
- Implement an effective system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
- Improve and develop the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.
- Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.