44 Dental Care

We carried out this announced inspection on 5 August 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.

As part of this inspection we asked:

• 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

44 Dental Care is based close to the centre of Leicester and provides NHS and predominantly private dental care and treatment for adults and children.

There is a small step to access to the practice, a portable ramp is available to aid access for people who use wheelchairs and those with pushchairs. The practice is located on a busy road so is unable to offer dedicated car parking spaces. Visitors are advised to park on neighbouring streets.

The dental team includes three dentists, three dental nurses, one of whom is an apprentice, one dental hygienist and one visiting oral surgeon. Reception duties are covered by the dental nurses. 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 one dentist and three dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Wednesday and Thursday from 9am to 5pm

Tuesday from 9am to 7pm

Friday from 9am to 2.30pm

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had infection control procedures which reflected published guidance. These were not always applied by staff.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available.
• The provider had systems to help them manage risk to patients and staff. However, we found shortfalls in appropriately assessing and mitigating risks in relation to legionella.
• 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, these were not consistently applied and recorded.
• 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 provider did not have effective leadership or a culture of continuous improvement in place.
• Staff 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 did not have effective information governance arrangements in place.
• We identified several shortfalls during our inspection. The provider responded swiftly to these and following our inspection we were sent evidence to demonstrate that many of them had been addressed. This assured us that the provider took our concerns seriously.

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.

• Improve the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular establish a robust, reliable system for recording checks of water temperature, and ensuring that where water temperatures had not reached the recommended level, any action taken to address this is recorded.

• Improve systems to ensure decontamination of dental instruments is carried out in a way that provides assurance they are clean and sterilised.

• Take action to ensure the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

• Implement an effective system of checks of medical emergency equipment and medicines taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

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:

• Improve the practice's processes for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.

• Improve the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.

• Take action to ensure the practice stores records relating to people employed and the management of regulated activities in compliance with legislation and take into account current guidance.