Chester Cosmetic Centre Limited

We undertook a follow up desk-based inspection of Chester Cosmetic Centre Limited on 10 September 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 remotely by a specialist dental adviser.

We undertook a comprehensive inspection of Chester Cosmetic Centre Limited on 17 June 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 well led care and was in breach of 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 Chester Cosmetic Centre Limited on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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 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 17 June 2019

Background

Chester Cosmetic Centre Limited is in Upton, near Chester. The practice provides private dental care for adults and children.

There is ramp access for people who use wheelchairs and those with pushchairs. Car parking is available outside the practice.

The dental team includes a principal dentist, two associate dentists, visiting dentists who provide periodontal treatment and orthodontic treatment, two dental hygienists, and three dental nurses, one of whom is a trainee. The dental team is supported by a practice manager. The practice has three 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 Chester Cosmetic Centre Limited is the principal dentist.

The practice is open:

Monday and Wednesday 9.00am to 5.00pm

Tuesday 9.00am to 6.30pm

Thursday 8.30am to 4.30pm

Friday 9.00am to 1.00pm.

Our key findings were:

• Systems to help them manage risk to patients and staff had improved.
• The provider had improved their staff recruitment procedures.
• Protocols for sharp’s injuries were detailed with appropriate contact information.
• Staff were provided with information regarding Gillick competency and the requirements of the Mental Capacity Act 2005.
• Medical emergency drugs and equipment was available in line with recognised guidance. The provider had improved their systems to monitor these.
• The provider had reviewed and acted to improve the security of the clinical waste bin.
• A colour-coded protocol for environmental cleaning was now in place for staff reference.
• Improvements were found in the practice’s radiography audit processes.

We carried out this announced inspection on 17 June 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 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 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

Chester Cosmetic Centre Limited is in Upton, near Chester. The practice provides private dental care for adults and children.

There is level access to facilitate entrance to the practice for people who use wheelchairs and for people with pushchairs. Car parking is available outside the practice. The provider had installed a ramp to facilitate access to the practice for wheelchairs and pushchairs.

The dental team includes a principal dentist, two associate dentists, visiting dentists who provide periodontal treatment and orthodontic treatment, two dental hygienists, and three dental nurses, one of whom is a trainee. The dental team is supported by a practice manager. The practice has three 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 Chester Cosmetic Centre Limited is the principal dentist.

We received feedback from eight people during the inspection about the services provided. The feedback provided was positive.

During the inspection we spoke to two dentists, a dental hygienist, dental nurses, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Wednesday 9.00am to 5.00pm

Tuesday 9.00am to 6.30pm

Thursday 8.30am to 4.30pm

Friday 9.00am to 1.00pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• Staff knew how to deal with medical emergencies. Appropriate medicines and equipment were available.
• The provider had staff recruitment procedures in place. Pre-employment checks were not consistently carried out and not all the required information was available for staff working at the practice.
• Staff provided patients’ care and treatment in line with current guidelines, including sedation guidelines.
• The dental team provided preventive care and supported patients to achieve better oral health.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints. The practice dealt with complaints positively and efficiently.
• The practice had a leadership and management structure and a culture of continuous improvement.
• The provider had systems in place to manage risk. Systems were not all operating effectively.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.

We identified regulations the provider was not complying with. 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 was not meeting are at the end of this report.

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

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. In particular, in relation to the accessibility of contact details for medical assistance should staff sustain an injury from a used sharp.
• Review staff awareness of Gillick competency, and of the requirements of the Mental Capacity Act 2005, and ensure all staff are aware of their responsibilities.
• Review the practice’s 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.