Solid Rock Specialist Dental Practice - Doncaster

We carried out an announced comprehensive inspection on 10 November 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this practice was not 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

Solid Rock Specialist Dental Practice is situated in Doncaster. The practice offers private routine dentistry, oral surgery and implants.

The practice comprises of two treatment rooms, one X-ray room, a decontamination room, a waiting and reception area, staff facilities and a patient toilet.

There are two dentists (one is the registered manager), two trainee dental nurses and a part time locum dental nurse.

The practice is open between 10:30am – 1:30pm and 5:00pm – 8:00pm Monday to Friday, 9:00am-1:00pm Saturday.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 received 11 CQC comment cards providing feedback. Patients who provided feedback were positive about the care and attention to treatment they received at the practice. Comments included that patients felt they were involved in all aspects of their care and found the staff to be very pleasant and helpful. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment. We were unable to speak to any patients as there were no patients booked in for appointments on the day.

Our key findings were:

• The practice did not have appropriate systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of incident reporting and medical emergencies.
• The practice was visibly clean and uncluttered.
• Staff had received safeguarding training, but could not clearly explain how to recognise signs of abuse and how to report it. They had systems in place to work closely and share information with the local safeguarding team.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were not fully embedded in accordance with the published guidelines.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Treatment was well planned and provided in line with current best practice guidelines.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients commented that they were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The practice was not well-led, but staff felt involved and supported and worked well as a team.
• The governance systems were not effective and embedded.
• The practice sought feedback from staff and patients about the services they provided.
• There was a defined leadership role within the practice and staff felt supported.

There were areas where the provider could make improvements and must:

• Introduce a risk assessment and action plan to mitigate the absence of an Automated External Defibrillator (AED).
• Introduce an effective fire risk management and safety check system.
• Introduce an effective process of transporting clean and dirty instrument to and from the decontamination room to bring the process in line with Health Technical Memorandum HTM 01-05, Decontamination in primary care dental practices.
• Introduce a risk assessment for using sharps, paying particular attention to the dental nurses handling and dismantling local anaesthetic syringes.
• Ensure appropriate measures are taken to receive and action Medicines and Healthcare Products Regulatory Authority alerts (MHRA) pertinent to the dental practice environment.
• Introduce policies and procedures to cover Reporting of Incident, Death and Dangerous Occurrences Regulations 2013(RIDDOR) and Significant Event reporting giving due regard to staff awareness and training.
• Introduce appropriate induction processes to protect staff safety during training and for new staff visiting on work placement. Review the current staff’s recruitment files and collate all documents required in schedule 3 of the regulations. Schedule 3 is the Information Required in Respect of Persons Employed or Appointed for the Purposes of a Regulated Activity.
• Introduce a Control of Substances Hazardous to Health (COSHH) assessment folder, produce COSHH risk assessments and obtain Safety Data Sheets for all COSHH identified materials to bring in line with COSHH Regulations 2002.
• Introduce a robust process of analysis for learning and improvement when auditing clinical and non-clinical areas of the practice.

There were areas where the provider could make improvements and should:

• Review the practice’s protocols on Safeguarding awareness and provide refresher training for all staff.
• Review the practice’s Health and Safety policy and source a Health and Safety Law poster, ensure staff are familiar with the policy and reporting procedures.
• Review the process for monitoring levels of appropriate Personal Protective Equipment in the decontamination room required by staff whilst handling dirty instruments to bring the process in line with Health Technical Memorandum HTM 01-05, Decontamination in primary care dental practices.
• Review the practice processes for ensuring emergency lifesaving equipment is fit for purpose, paying attention to expiry dates.
• Review the practice answer machine and provide emergency out of hours contact details.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review and complete the practice risk assessments and ensure all staff are aware of the contents.
• Review the current process to ensure qualified staff have appropriate indemnity prior to working in the clinical environment.