Puredental - Allerton Road

We undertook a follow up inspection of Puredental – Allerton Road on 3 February 2020. 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 Puredental – Allerton Road on 1 October 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 care and was in breach of regulation 12 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 Puredental – Allerton Road on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

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 area 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 breach we found at our inspection on 1 October 2019.

Background

Pure Dental – Allerton Road is in south Liverpool and provides private dental treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs; this is through a staff entrance. Access can be facilitated by contacting the practice before any appointments. Car parking is available nearby.

The dental team includes three dentists, three dental nurses and a receptionist. The practice has two treatment rooms.

The practice is owned by a company 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 Pure Dental – Allerton Road is the principal dentist.

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

The practice is open from Monday to Friday from 8.50am to 5.50pm, with later opening on Thursday evening until 7.50pm. The practice is open on Saturday from 9am to 4pm.

Our key findings were:

• The provider had infection control procedures which reflected published guidance. This covered staff uniforms and the laundering of these, and the audit and management of cleaning and cleaning equipment.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Evidence of electrical safety testing for fixed wiring in the building was held by the provider. Portable appliances had also been checked and passed as safe for use.
• Management of X-ray equipment was effective and took account of associated guidance and regulations. The provider held evidence of the required continuing professional development for staff who used X-ray equipment.
• All staff had received updated training on Gillick competence and the Mental Capacity Act. We observed that this was reflected in patient records and in consent procedures.
• An updated, detailed whistleblowing policy was in place. All staff had access to this; staff we spoke with could explain and describe actions they would take if they had concerns about the practice of any member of staff or visiting clinician.
• Antibiotic prescribing was in line with updated guidance and was audited.
• Dentists were using appropriate safety devices when providing dental treatment. Dentists recorded in patient notes the use of rubber dam and instances when this was not used, detailing other safety devices used as appropriate.

We carried out this announced inspection on 01 October 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 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 providing well-led care in accordance with the relevant regulations.

Background

Pure Dental – Allerton Road is in south Liverpool and provides private dental treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs; this is through a staff entrance. Access can be facilitated by contacting the practice before any appointments. Car parking is available nearby.

The dental team includes three dentists, three dental nurses, a receptionist and a practice manager. The practice has two treatment rooms.

The practice is owned by a company 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 Pure Dental – Allerton Road is the principal dentist.

On the day of inspection, we collected 20 CQC comment cards filled in by patients. All comments were highly positive about the practice staff and care and treatment they provided.

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

The practice is open from Monday to Friday from 8.50am to 5.50pm, with later opening on Thursday evening until 7.50pm. The practice is open on Saturday from 9am to 4pm.

Our key findings were:

• The practice appeared clean and well maintained. The audit and management of cleaning, and cleaning equipment could be improved.
• The provider had infection control procedures which reflected published guidance. Some governance around this could be further developed.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Some items held were not in line with published guidance.
• Antibiotic prescribing in some cases was not in line with updated guidance.
• The provider had systems to help them manage risk to patients and staff. These required improvement in relation to management of X-ray equipment.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• A greater understanding of Gillick competence and the Mental Capacity Act could improve record keeping in respect of patient records.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement. Increased use of audit could help drive improvement in this area.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified a regulation the provider was not complying with. They must:

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

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

• Improve and develop staff awareness of Gillick competence and ensure all staff are aware of their responsibilities in relation to this.
• Improve the practice's systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular the development of an effective whistleblowing policy.