25 November 2022
During a routine inspection
We carried out this announced comprehensive inspection on 25 November 2022 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 practice 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 advisor.
To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:
- The dental clinic was visibly clean and well-maintained.
- The practice had infection control procedures which reflected published guidance.
- Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
- Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Patients were treated with dignity and respect and staff 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.
- There was effective leadership and a culture of continuous improvement.
- Staff felt involved and supported and worked as a team.
- Staff and patients were asked for feedback about the services provided.
- Complaints were dealt with positively and efficiently.
- The dental clinic had information governance arrangements.
- The practice had some systems to help them manage risk to patients and staff. Improvements were needed to ensure risks from using sharps were identified, assessed and mitigated.
- The practice had staff recruitment procedures which broadly reflected current legislation. Improvements were needed to ensure that the appropriate recruitment checks were carried out at the time of employment for all new members of staff.
Background
Broadway Dental Practice is in the London Borough of Barnet and provides NHS and 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 near the practice. The practice has made reasonable adjustments including having accessible treatment rooms to support patients with additional needs.
The dental team includes the principal dentist, 1 associate dentist, 1 visiting oral surgeon, 4 dental nurses, 1 trainee dental nurse, 1 dental hygienist and 2 receptionists. They are supported by a practice manager and 1 administrative staff. The practice has 3 treatment rooms.
During the inspection we spoke with the principal dentist, the associate dentist, the registered manager, the two receptionists and one dental nurse. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday to Friday 9.30 am to 5.30pm
There were areas where the provider could make improvements. They should:
- Improve the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
- Implement an effective recruitment procedure to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
- Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and take into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.