Abbeyside Dental Practice

We undertook a follow up focused inspection of Abbeyside dental practice on 9 January 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 dental practice adviser from NHS England.

We undertook a comprehensive inspection of Abbeyside dental practice on 16 July 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 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 Abbeyside 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 and send us an action plan (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

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 July 2019.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

The provider had made insufficient improvements to put right the shortfalls and had not responded adequately to the regulatory breach we found at our inspection on 16 July 2019.

Background

Abbeyside dental practice is in Stoke on Trent and provides NHS and private treatment to adults and children.

The entire practice is situated on the first floor and there is no level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available immediately outside the practice in their own car park.

The dental team includes one dentist, two dental nurses (who are also the practice managers), two trainee dental nurses and one receptionist. One dental nurse was on a period of extended leave at the time of our visit. The practice has two treatment rooms and a separate room for carrying out decontamination.

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 dentist and two dental nurses (who were the practice managers). We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9am and 5pm from Monday to Friday.

Our key findings were:

• Improvements were made in areas such as the servicing of equipment, electrical safety, staff training, fire safety, and the introduction of some policies.
• The provider had taken action to address some of the issues that we identified at our previous inspection. However, there were significant delays associated with resolving some of these issues.
• Many shortfalls remained and had not been resolved. These related to areas such as audits, evidence of immunisation status for clinical staff and recruitment processes.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.

We carried out this announced inspection on 16 July 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

Abbeyside dental practice is in Stoke on Trent and provides NHS and private treatment to adults and children.

The entire practice is situated on the first floor and there is no level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available immediately outside the practice in their own car park.

The dental team includes one dentist, two dental nurses (who were also the practice managers), two trainee dental nurses and one receptionist. One dental nurse was on maternity leave at the time of our visit. The practice has two treatment rooms and a separate room for carrying out decontamination.

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 33 CQC comment cards that had been completed by patients. We spoke with the dentist, both dental nurses and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open between 9am and 5pm from Monday to Friday.

Our key findings were:

• The practice appeared clean and well maintained, although we identified some areas that required improvement.
• The provider had infection control procedures which mostly reflected published guidance. Some improvements were however required.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available but checks needed to be completed more frequently. All staff had completed training though one member’s training was overdue.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Not all staff had completed training to the required level.
• 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 supported patients to ensure better oral health.
• 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.
• The provider had suitable information governance arrangements.
• Validation tests for the autoclaves and ultrasonic cleaning bath were not in line with current national guidance.
• Evidence was not available that gas safety and five year electrical safety checks had been undertaken.
• The provider did not have robust recruitment procedures.
• The provider had limited systems to help them manage risk to patients and staff.
• The practice had ineffective leadership and a lack of oversight of governance.

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:

• Review the practice’s protocols for the use of closed-circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.
• Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.