Highbury Dental Care

We undertook a focused inspection of Highbury Dental Care on 18 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 remotely by a specialist dental adviser.

We undertook a comprehensive inspection of Highbury Dental Care on 16 September 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, effective or well led care and was in breach of regulations 12, 17 and 19 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 Highbury Dental Care on our website www.cqc.org.uk.

As part of this inspection we asked: Remove as appropriate:

• Is it safe?

• Is it effective?

• 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 breaches we found at our inspection on 16 September 2019.

Are services effective?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 16 September 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 breaches we found at our inspection on 16 September 2019.

Background

Highbury Dental Care is in the Bulwell area of Nottingham and provides NHS and private treatment for adults and children.

There is level access to the practice for people who use wheelchairs and those with pushchairs and an automatic front door. Car parking spaces, including dedicated parking for people with disabilities, are available near the practice.

The dental team includes two dentists, three dental nurses who also had reception duties. The practice has three treatment rooms and centralised decontamination facilities.

The practice is owned by an organisation and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Highbury Dental Care is one of the providers, they are not based at Highbury Dental Care.

During the inspection we spoke with the provider. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday: from 9am to 8pm, Tuesday to Thursday: from 9am to 5pm and Friday: from 9am to 2pm.

Our key findings were:

• The safeguarding policy had been reviewed and now clearly identified who was the safeguarding lead.
• Staff recruitment records were in accordance with Schedule 3 of the Health and Social Care Act 2008 Regulations.
• The fire risk assessment had been reviewed and outstanding actions had been completed.
• Since the last inspection in September 2019, radiography audits had been completed for all dentists working at the practice.
• The local rules for all X-ray machines had been reviewed and updated.
• There was evidence that every member of staff had been immunised against the Hepatitis B virus and had immunity.
• Medical emergency equipment had been reviewed and all equipment identified in national guidance was available.
• Risk assessments had been completed for each substance identifiable under the Control of Substances Hazardous to Health (COSHH) regulations.
• Since the last inspection in September 2019, two infection prevention and control audits had been completed.
• A tracking system for NHS prescriptions had been devised and was ready to be put into use.
• Antimicrobial audits had been completed in September 2019.
• The system for recording significant events had been reviewed and significant events discussed in a staff meeting with all staff.
• The arrangements for identifying sepsis had been reviewed. Posters were on display and staff had received training.
• A new dentist had been recruited to address the issue of cancelled appointments.
• Duty of candour policy was discussed with all staff in September 2019. A new policy had been introduced in January 2020.
• The system for audits had been reviewed, and two members of staff had been recruited to specifically complete audits within the organisation.

We carried out this announced inspection on 16 September 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 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

Highbury Dental Care is in the Bulwell area of Nottingham and provides NHS and private dental treatment to adults and children.

The dental team includes three dentists, three trainee dental nurses, one receptionist and a practice manager. The practice has three treatment rooms and an instrument decontamination room. All three treatment rooms are located on the ground floor. There is a ramp with handrails to provide ease of access into the practice for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the practice and on local roads. There is parking space at the front of the practice for blue badge holders and those with restricted mobility.

The practice is owned by an organisation and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Highbury Dental Care is the provider. The registered manager is not based at Highbury Dental Care.

On the day of inspection, we collected 21 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, two dental nurses, the practice manager and the provider. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from: 9am to 8pm, Tuesday to Thursday from: 9am to 5pm and Friday from: 9am to 2pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, with the exception of a full set of clear oxygen face masks
• Improvements could be made to the provider’s systems to help them identify and manage risk to patients and staff.
• The provider had systems for managing sharp instruments.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Improvements could be made to ensure staff understood who was the lead person for safeguarding.
• The provider needed to make improvements to the system for assessing materials and substances that are hazardous to health.
• Improvements were needed to the provider’s system for appraising staff performance.
• Actions identified in the fire risk assessment had not been completed.
• Improvements were need to the provider’s staff recruitment procedures and checks of staff immunity to the Hepatitis B virus.
• 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.
• The provider’s system for identifying and recording significant events needed to be reviewed.
• Improvements were needed to the systems for ensuring the security of NHS prescription pads.
• The audit of infection prevention and control in the practice was not robust.
• Staff provided preventive care and supporting patients to ensure better oral health.
• Staff were not aware of the risk of sepsis.
• The appointment system took account of patients’ needs.
• 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.
• Improvements were needed to the provider’s system for quality assurance.
• The provider had suitable 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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

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

• Improve staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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