Hazlemere Dental Practice

We undertook a follow up focused inspection of Hazlemere Dental Practice on 6 February 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 by a specialist dental adviser.

We found the registered provider was not providing well led care and was in breach of regulation 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 Hazlemere Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

Our findings were:

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 23 August 2019.

Background

Hazlemere Dental Practice is in Holmer Green, High Wycombe and provides NHS treatment to children and private treatment to adults and children.

The practice has level access (via a portable ramp) for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for disabled people are available at the front and rear of the practice.

The dental team includes four dentists, three dental nurses, one dental hygienist and two receptionists. 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 the one dentist, one dental nurse and two receptionists.

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

The practice is open:

• Monday 08:30 - 19:30
• Tuesday 08:30 - 19:30
• Wednesday 08:30 - 18:00
• Thursday 08:30 - 19:30
• Friday 08:30 - 13:00

Our key findings were:

• The provider’s infection control procedures reflected published guidance.
• Appropriate medicines and life-saving equipment was available.
• The provider had systems to help them manage risk to patients and staff.
• The practice had effective clinical and management leadership.

We carried out this announced inspection on 23 August 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 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 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 not providing well-led care in accordance with the relevant regulations.

Background

Hazlemere Dental Practice is in Holmer Green, High Wycombe and provides NHS treatment to children and private treatment to adults and children.

The practice has level access (via a portable ramp) for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for disabled blue badge holders, are available at the front and rear of the practice.

The dental team includes four dentists, three dental nurses, one dental hygienist and two receptionists. 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.

On the day of inspection, we collected nine CQC comment cards filled in by patients and obtained the views of 15 other patients.

During the inspection we spoke with two dentists, one dental nurse, one dental hygienist and one receptionist.

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

The practice is open:

• Monday 08:30 - 19:30
• Tuesday 08:30 - 19:30
• Wednesday 08:30 - 18:00
• Thursday 08:30 - 19:30
• Friday 08:30 - 13:00

Our key findings were:

• The practice appeared clean and well maintained.
• The provider’s infection control procedures did not reflect published guidance.
• Staff knew how to deal with emergencies.
• Appropriate medicines and life-saving equipment availability required improvement.
• The provider had systems to help them manage risk to patients and staff but did not operate these effectively.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• 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 supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well 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 suitable information governance arrangements.
• The practice did not have effective clinical and management leadership.

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. Specificity management of COSHH, infection control, sharps, fire safety, medicines, legionella, emergency medicines and equipment, and staff appraisals.

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

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

• Implement an effective system for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.
• 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 service takes into account the needs of disabled patients and to comply with the requirements of the Equality Act 2010. Specifically, arrangements to support patients who experienced sight or hearing loss.