Archived: Alan Jones Dental Surgery

Updated 14 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was carried out on the 10 November 2015 and was led by a CQC inspector and a dental specialist advisor.

We informed Healthwatch that we were inspecting the practice; however we did not receive any information of concern from them.

The methods that were used to collect information at the inspection included interviewing staff, observations and review of documents also talking to people using the service.

During the inspection we spoke with the dentist, a dental nurse and the receptionist. We saw policies, procedures and other records relating to the management of the service. No Care Quality Commission comment cards had been completed prior to the inspection.

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 14 January 2016

We carried out an announced comprehensive inspection on 10 November 2015 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

Alan Jones Dental Surgery is located in the seaside town of Hornsea, in the East Riding of Yorkshire. The premises are situated in the town centre, close to car parking facilities. The practice provides a service to private patients.

The practice is open:

Monday - Wednesday 08:30 - 17:30

Thursday 09:00 - 16:30

Friday 08:30 - 14:00

CQC previously inspected the practice on 22 May 2013 and 2 October 2013 and asked the provider to make improvements regarding the care and welfare of people who use the service, infection prevention and control and to monitor the quality of service provisions. We checked these areas as part of this comprehensive inspection and found this had not been embedded in the practice.

The practice owner is the registered provider. 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.

During the inspection we spoke to four patients who used the service. We sent CQC comment cards to the practice two weeks prior to our visit for patients to tell us what they thought about the practice. We did not receive any written CQC comment cards and observed the cards and the box at the reception area. However all the comments were positive about the staff and the services provided. Comments included: the practice was safe and hygienic; staff were very caring and polite and they were impressed with the services.

Our key findings were:

• The practice did not have emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• The practice did not have access to an automated external defibrillator and the medical oxygen cylinder available on the premises had no supporting evidence that it had been serviced or replaced.
• Governance arrangements were in not place for the smooth running of the practice; the practice did not have a structured plan in place to audit quality and safety including infection control, radiographs and patient care records.
• Staff had not received safeguarding training, however they knew how to recognise signs of abuse but not how or who to report it to.
• A legionella risk assessment had had not been completed.
• Staff had been trained to manage medical emergencies, however this training was completed in November 2013.

We identified regulations that were not being met and the provider must:

• Ensure availability and checks of all medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK).
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure the practice’s protocols are reviewed for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulation (IR(ME)R) 2000.
• Ensure audits of various aspects of the service, such as radiography and dental care records, are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points so the resulting improvements can be demonstrated.
• Review its audit protocols to document learning points that are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.
• Ensure that the practice is compliant with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure a risk assessment for legionella testing is completed and action plan implemented in accordance with the findings.
• Ensure all staff have CPR and medical emergency training.
• Ensure all staff receive necessary training and performance appraisals and are suitably supported in undertaking their activities.

You can see full details of the regulations not being met at the end of this report.

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

• Adopt an individual risk based approach to patient recalls having regard to National Institute for Health and Care Excellence (NICE) guidelines.
• Review the practice protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention.
• Review at appropriate intervals the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.
• Maintain accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded.
• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• 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.
• Establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints by service users also ensure this is easily accessible to patients.
• Review the storage of dental care records to ensure they are stored securely.
• Review the practice's recruitment policy and procedures to ensure character references for new staff as well as proof of identification are requested and recorded suitably.