West Malling Dental Practice and Implant Centre

We carried out this focused unannounced inspection on 19 November 2021 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 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 three questions:

• Is it safe?

• Is it effective?

• 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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services well-led?

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

Background

West Malling Dental Practice and Implant Centre is in West Malling 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, including dedicated parking for people with disabilities, are available near the practice.

The dental team includes four dentists, two dental nurses, four trainee dental nurses, two also cover reception a dental hygienist, and a receptionist. The practice has three treatment rooms.

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 two dentists, two dental nurses, a trainee dental nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Thursday 8.30am to 5.30pm

Tuesday and Wednesday 8.30am to 7pm

Friday 8.30am to 4.30pm

Saturday 9am to 1pm

Our key findings were:

• The practice appeared to be visibly clean, but improvements could be made to areas of the practice. We saw some areas that were not well-maintained.
• The provider had infection control procedures which did not wholly reflect published guidance.
• We were not assured staff knew how to deal with emergencies, as some staff were not trained and did not know where some emergency equipment was kept. Not all the required appropriate medicines and life-saving equipment were available.
• The provider had some systems to help them manage risk to patients and staff, this requires improvement.
• The provider did not have sufficient safeguarding processes and some staff did not know their responsibilities for safeguarding vulnerable adults and children.
• The provider did not have staff recruitment procedures which reflected current legislation.
• 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.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider did not have an effective leadership and a culture of continuous improvement.
• Staff told us they felt involved and supported and worked 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 some information governance arrangements.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation/s the provider was not meeting are at the end of this report.

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

• Implement protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
• Take action to ensure the clinicians take into account the guidance provided by the College of General Dentistry when completing dental care records.
• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the College of General Dentistry.
• Improve the practice protocols regarding auditing patient dental care records to check that necessary information is recorded.

Develop systems to ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff. Including the training, learning and development needs of individual staff members at appropriate intervals.