Archived: Stanstead Road Dental Practice Limited

We undertook a follow up focused inspection of Stanstead Road Dental Practice on 9 December 2019. 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 accompanied by a specialist dental adviser.

We undertook a comprehensive inspection of Stanstead Road Dental Practice on 9 May 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 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included Regulation 12 -Safe care and treatment and Regulation 17 - Good governance. You can read our report of that inspection by selecting the 'all reports' link for Stanstead Road Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements.

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 9 May 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 9 May 2019.

Background

Stanstead Rd Dental Practice Limited is in the London borough of Lewisham and provides NHS and private dental treatment to adults and children. There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice for limited periods during the day.

The dental team includes three dentists, two dental nurses, one trainee dental nurse, two receptionists, one practice manager.

The practice is owned by a company 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 Stanstead Rd Dental Practice Limited is one of the company directors. A registered manager is legally responsible for the delivery of services for which the practice is registered

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had systems to help them manage risk to patients and staff.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The appointment system took account of patients’ needs and emergency provision.
• The provider had effective leadership and a culture of continuous improvement.
• 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 had information governance arrangements.
• The practice had arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.

We carried out this announced inspection on 9 May 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

Stanstead Rd Dental Practice Limited is in the London borough of Lewisham and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice for limited periods.

The dental team includes one dentist, one dental nurse, one trainee dental nurse, one dental practice manager and a company director. The practice has two treatment rooms, however, only one is currently in use.

The practice is owned by a company 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 Stanstead Rd Dental Practice Limited is the company director. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection received feedback from three patients.

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

The practice is open:

Monday -8.30am - 5.45pm

Tuesday-10am -7.45pm

Wednesday and Thursday -9am -5.45pm

Friday -9am -4.45pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• The provider had appropriate staff recruitment procedures.
• The provider asked patients for feedback about the services they provided.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The provider had systems to deal with complaints efficiently.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff treated patients with dignity and respect; however, they did not always take care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system did not always take into account of patients’ needs.
• Staff did not always feel involved and supported.
• Staff knew how to deal with emergencies. However, not all emergency medicines and life-saving equipment, was available as per national guidance.
• There was no emergency lighting and no fire detection system in place.
• An up to date fire risk assessment was not available. The previous risk assessment was undertaken in 2010 and not all recommendations had been completed.
• The provider did not have suitable arrangements to ensure the safety of the X-ray equipment.
• There were ineffective governance arrangements in place.
• There were insufficient systems in place to manage risk to patients and staff.
• The provider did not demonstrate effective leadership nor was there a culture of continuous improvement.

We identified regulations the provider was not complying with. They must:

• Ensure that care and treatment is provided to patients in a way that is safe
• 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 availability of an automated external defibrillator, (AED), in the practice to manage medical emergencies, taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council, and undertake a risk assessment if a decision is made not to have an AED on site.

Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.

Review the practice's protocol and 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.