Derwent Valley Dental

We undertook a focused inspection of Derwent Valley Dental on 5 March 2020. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported remotely by a specialist dental adviser.

We undertook a comprehensive inspection of Derwent Valley Dental on 19 November 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing safe or well-led care and was in breach of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Derwent Valley Dental on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breach we found at our inspection on 19 November 2019.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breach we found at our inspection on 19 November 2019.

Background

Derwent Velley Dental is in the Chaddesden area of Derby and provides NHS dental treatment to adults and children.

The dental team includes one dentist, two dental nurses and four receptionists. The practice has one ground floor treatment room. There is level access into the practice and treatment room, which is of benefit to patients in wheelchairs, with restricted mobility and parents with pushchairs. On-site car parking is available.

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 the dentist 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: from 8am to 6pm, Tuesday: from 8am to 8pm, Wednesday: from 8am to 12 noon, Thursday: 8am to 6pm and Friday: from 8.30 to 5pm. The practice closes for lunch for one hour each day.

Our key findings were:

• A log had been introduced to track NHS prescriptions within the practice.

• The system for single use items had been reviewed and they were no longer being re-used in the practice.

• The practice had written a risk assessment for endodontic procedures. The risk assessment identified the alternatives being used instead of a dental dam.

• The medical oxygen cylinder had been replaced with a larger version.

• A new infection prevention and control audit had been completed in December 2019. An action plan had been produced following this audit with action points for staff.

• A new stock control system has been developed with checks recorded to monitor use by dates for dental materials.

• The damaged floor plate in the treatment room had been repaired and both the dental chair and the dentist’s stool had been re-upholstered.

• A new system had been introduced to monitor emergency medicines and equipment, with regular checks and records of those checks.

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 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 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

Derwent Velley Dental is in the Chaddesden area of Derby and provides NHS dental treatment to adults and children.

The dental team includes one dentist, two dental nurses and four receptionists. The practice has one ground floor treatment room. There is level access into the practice and treatment room, which is of benefit to patients in wheelchairs, with restricted mobility and parents with pushchairs. On-site car parking is available.

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 15 CQC comment cards filled in by patients and spoke with two other patients. Comments from patients were all positive about the dental care and treatment they had received.

During the inspection we spoke with one dentist, one dental nurse and a receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday: from 8am to 6pm, Tuesday: from 8am to 8pm, Wednesday: from 8am to 12pm, Thursday: from 8am to 6pm, and Friday: from 8am to 5pm.

The practice is closed for lunch: from 12pm to 1.30pm.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• Improvements were needed in infection control procedures to ensure they reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, apart from medical oxygen which did not have sufficient amounts in the case of an emergency.
• The provider’s systems to help them manage risk to patients and staff required improvement.
• The provider did not use a dental dam when carrying out root canal treatments. Alternative methods of protecting the patients’ airway during the procedure were not recorded.
• 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.
• The clinical staff provided patients’ care and treatment in line with current guidelines. There was room for improvement in relation to the use of X-rays as a diagnostic tool.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Systems and processes for stock control could be improved.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider’s quality assurance systems could be improved.
• 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 had information governance arrangements.

We identified regulations the provider was not complying with. 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.

Full details of the regulations the provider is not meeting are at the end of this report.

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

• Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.

• Take action to ensure the clinicians carrying out patient assessments are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance. Particularly in relation to the use of X-rays as a diagnostic tool and taking into account guidance from the Faculty of General Dental Practice.