Old Square Dental Surgery

We carried out this announced inspection on 19 November 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 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 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 this practice was 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 caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive 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

Old Square Dental Surgery is in Warwick and provides NHS and private dental care and treatment for adults and children. There are two services provided by two different providers at this location. This report only relates to the provision of general dental care services provided by Dr. Robert Bate. An additional report is available in respect of the orthodontic service which is registered under the provider Old Square Orthodontics Ltd.

There is low level step access to the practice with a gradient that is unsuitable for a portable ramp to be used. Patients who use wheelchairs and those with pushchairs are supported by those accompanying them or staff to access the premises. Car parking spaces, including dedicated parking for people with disabilities, are available in pay and display car parks near to the practice.

The dental team includes four dentists, one orthodontist, six dental nurses, two dental hygienists, three receptionists and the practice manager. The practice has five 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.

On the day of inspection, we collected 14 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, four dental nurses, one dental hygienist, three receptionists 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 to Thursday from 8.30am to 5.30pm.

Friday from 8.30am to 4.30pm.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had infection control procedures which reflected published guidance. There were three areas that were being used for decontamination processes. We noted inconsistency in staff following the practice policy and processes when undertaking manual cleaning of the dental instruments.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had insufficient systems to help them manage risk to patients and staff. We found shortfalls in appropriately assessing and mitigating risks in relation to electrical wiring testing, infection control processes, prescribing, record keeping and audit.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures which reflected current legislation.
• We were not assured that clinical staff always 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 demonstrate effective leadership and a culture of continuous improvement. Staff meetings and appraisals were not held, we were assured these would be implemented following our inspection.
• The provider asked patients for feedback about the services they provided.
• The provider had procedures to deal with complaints; they had not received any complaints since 2011.
• The provider had information governance arrangements.
• The provider demonstrated they were taking responsive action to the shortfalls we identified following our visit.

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 regulations the provider was not meeting are at the end of this report.

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

• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.

• Take action to ensure dentists are aware of the guidelines issued by the British Endodontic Society for the use of dental dams for root canal treatment.