Dental Practice - Barkingside

We carried out this announced inspection on 14 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection in response to concerns we received and 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 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 that this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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

Dental Practice - Barkingside is in Ilford in the London Borough of Redbridge. The practice provides NHS and private treatments to patients of all ages.

The practice is situated close to public transport bus services.

The dental team includes the principal dentist who owns the practice, one associate dentist, one specialist periodontist and two trainee dental nurses.

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 received feedback from 25 patients.

During the inspection we spoke with the principal and two trainee dental nurses.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday from 9am to 5.30pm.

Our key findings were:

• Staff knew how to deal with emergencies.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice appeared generally clean and well maintained.
• The practice infection control procedures did not reflect published guidance. Staff did not have appropriate infection prevention and control training. Clinical waste was not disposed of suitably and staff did not have suitable immunity against vaccine preventable infectious diseases.
• The practice had limited systems to help them manage risk. There were no Legionella or sharps risk assessments available. Risk assessments that were carried out were not completed properly nor used to help understand and mitigate the risks.
• The practice had arrangements for the safe use of medicines and equipment. Improvements were needed so that the dentists used a rectangular collimator taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment and that temperature sensitive medicines requiring refrigeration were stored appropriately.
• The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Not all staff had completed safeguarding training.
• The practice staff recruitment procedures were not followed so that all of the essential checks were carried out. Staff were not suitably trained or supported to carry out their duties.
• The clinical staff did not always provide patients’ care and treatment in line with current guidelines.
• The practice was not providing preventive care and supporting patients to ensure better oral health.
• There was ineffective leadership and a lack of clinical and managerial oversight for the day-to-day running of the service.
• The practice did not have suitable information governance arrangements.

We identified regulations the provider was not meeting. 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.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Ensure specified information is available regarding each person employed

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

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
• Review the practice’s systems in place for environmental cleaning taking into account current national guidelines.
• Review its responsibilities as regards the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use and handling of these substances.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. This relates specifically to the use of rectangular collimation.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review practice protocols for patient assessments and ensure they are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance.
• Review the practice’s protocols for referral of patients and ensure urgent referrals are monitored suitably.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
• Review the practice’s protocols for referral of patients and ensure urgent referrals are monitored suitably.