The Care Quality Commission
  • Dentist
  • Dentist

Castelnau Dentists

200 Castelnau, Barnes, London, SW13 9DW (020) 8563 7177

Provided and run by:
Castelnau Dentists

All Inspections

26/01/2023

During a routine inspection

We carried out this announced comprehensive inspection on 26 January 2023 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 practice 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 advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:

  • The dental clinic appeared clean and well-maintained.
  • The practice had infection control procedures which reflected published guidance.
  • Staff knew how to deal with medical emergencies. Improvements were required to ensure all appropriate life-saving equipment was available as per current national guidance.
  • Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • The practice had staff recruitment procedures which reflected current legislation.
  • Clinical staff provided patients’ care and treatment in line with current guidelines.
  • Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
  • Staff provided preventive care and supported patients to ensure better oral health.
  • The appointment system worked efficiently to respond to patients’ needs.
  • The frequency of appointments was agreed between the dentist and the patient, giving due regard to National Institute of Health and Care Excellence (NICE) guidelines.
  • There was effective leadership and a culture of continuous improvement.
  • Staff felt involved, supported and worked as a team.
  • Staff and patients were asked for feedback about the services provided.
  • Complaints were dealt with positively and efficiently.
  • The practice had information governance arrangements.
  • The practice had systems to manage risks for patients, staff, equipment and the premises.
  • Improvements were required with regard to the storage of hazardous substances.

Background

Castelnau Dentist is in the London Borough of Richmond upon Thames and provides NHS and private dental care and treatment for adults and children.

There is step free access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made reasonable adjustments to support patients with access requirements.

The dental team includes 5 dentists, 3 dental nurses, 1 trainee dental nurse, 2 dental hygienists, 1 practice manager and 2 receptionists. The practice has 5 treatment rooms.

During the inspection we spoke with 4 dentists, 1 dental nurse, the trainee dental nurse, 1 dental hygienist, 1 receptionist and the practice manager. We looked at practice policies, procedures and other records to assess how the service is managed.

The practice is open:

Monday to Friday 8am to 4pm

Saturday 8.20am to 1.30pm

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

  • Take action to ensure the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

  • Improve the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.

  • Improve the practice's processes for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.

  • Implement a system to ensure patient referrals to other dental or health care professionals are centrally monitored to ensure they are received in a timely manner and not lost.

During a check to make sure that the improvements required had been made

Our inspection of 10 October 2013 found that while improvements had been made to record management and audit, systems for maintaining records were ineffective and put people's care and treatment at risk. Some people were not being asked for updates of their medical history, signatures or dates. Some documents were incomplete.

We wrote to the provider and asked them to send us a report of the changes they would make to become compliant. The provider sent us an action plan telling us how they would become compliant. We checked whether the changes had been made in December 2013. We found that improvements had been made and the provider was meeting the standard.

We spoke with three staff who explained the newly implemented record management procedure. Records were prepared a day before appointments and checked for accuracy and missing data. Patients were asked to sign, date, and provide currency of information about their medication and health. A dental nurse collected the patient and their records and took them to the dentist. The dentist reviewed their dental and general health before treatment began. Records were returned to reception where they were updated and passed to senior staff for quality audit.

We asked senior staff to audit three paper and electronic records as part of the follow up review. We spoke with three patients who each confirmed the new process. Senior staff agreed to review records relating to newly recruited staff and the employment policy.

10 October 2013

During an inspection looking at part of the service

People's personal records including medical records were not always accurate and fit for purpose. Important records requiring patient signatures and dates of treatment were not always being fully completed or signed by the patient.

Our inspection of 22 July 2013 found that people were not adequately protected from the risk of unsafe or inappropriate care and treatment arising from a lack of proper information about them. Electronic records did not show how patients' options for treatments, the advantages and risks associated with these treatments were being discussed and recorded. We wrote to the provider and they told us that they would review their procedures. We returned on 10 October 2013 and found that while some improvements had been made, there were inconsistencies in both paper and electronic records.

We looked at nine electronic and paper records of patients receiving a service from Castelnau Dental practice between 16 September and the 10 October 2013. Electronic records showed clearly the comparisons between the risks and benefits of each option available to patients. Key paper documents including consent to examination and treatments called Practice Record Form Patient Declaration and Treatment Plans were either not signed and/or not dated.

We were informed by staff that they had not started to audit and monitor records as part of their wider audit process, which meant that errors and omissions of information were not being identified and addressed.

22 July 2013

During a routine inspection

During our inspection we spoke with eleven people who used the service. We asked people how involved they were in decisions about their care and treatment. Someone said "My dentist involves me in all the treatments and choices we discuss". We asked people how their consent was sought. While some people remembered signing for treatments the majority of the people explained that they discussed their care with the dentist and agreements were informal. Each of the people we talked with spoke commendably about the dentists and staff. One person told us "My dentist is very good; they explain the procedures thoroughly".

Our inspection of December 2012 found that staff at Castelnau were unaware of how to address potential cases of abuse or the actions they should take. We returned in July 2013, and found that staff had received training. The safeguarding policy had been reviewed. In 2012 the practice was not operating systems designed to regularly assess and monitor the quality of the service provided. At our inspection in July 2013, we found that the provider had reviewed their polices and was providing feedback opportunities to people using the service.

We spoke with dental staff and asked them about their development. Staff gave examples of how they wanted to pursue their clinical skills and advance their knowledge.

We looked at records and found inconsistencies in how information was recorded. While some people's records were complete, others lacked sufficient detail.

19 April 2013

During a routine inspection

We inspected this service on 7 December 2012 and found that cleaning schedules were not being checked and there were concerns with aspects of the cleanliness and hygiene. The provider sent us an action plan advising how this would be addressed. We visited again in April 2013 as part of a follow up inspection and spoke with six members of staff.

Some staff explained that they were aware of the most recent decontamination procedures and national guidelines. Someone told us "we have a new cleaning schedule for staff to follow". We checked the daily cleaning records in two surgeries and these were being completed more often than on our previous visit. The provider may wish to note however, the records were not completed on a daily basis and so there were gaps in the recording of cleaning schedules.

We also found that storage of data relating to the testing of one of the sterilizing systems was poor. Most staff explained that endodontic files used for root canal treatment were not re-used on other clients, bit other staff were not sure whether endodontic files could be re used on other clients after sterilization.

We were shown new dirty to clean zones in two surgeries and new processes for separating the washing and rinsing of used instruments. One staff member said "we have marked out the dirty to clean zones for staff to follow to reduce the risk of contamination". These guidelines were clearly marked and visible for staff to follow.

14 December 2012

During an inspection in response to concerns

We inspected Castelnau dental practice as part of a responsive review following information of concern we had received about the practice. We spoke with five staff and asked them to show us how the practice was cleaned and how instruments used for dental were cleaned and maintained. We asked staff to show us instruments used at the practice and how these were prepared for use and stored following cleaning. We asked to view records and cleaning schedules at the practice and discussed how these records were recorded, maintained and updated.

We also asked to look at how the practice monitored its service and the processes it used to audit cleaning, the preparation and use of equipment and other essential aspects of the service. We asked to look at records and documents relating to monitoring and audit, however the practice maintained insufficient records and documents to support effective audit.

The practice had a child protection policy but there was no vulnerable adult policy and staff had not completed recent training in relation to safeguarding. There were very few details in records and documents for us to inspect related to the safeguarding and protection of vulnerable children and adults. As part of our inspection we consulted with a specialist dental lead, the British Dental Health Association (BDHA) and the General Dental Council (GDC).