Highfield Clinic

We undertook a follow up focused inspection of Highfield Clinic on 24 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 by a specialist dental adviser.

We undertook a comprehensive inspection of Highfield Clinic on 2 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 regulation 12 and 17 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 Highfield Clinic on our website www.cqc.org.uk.

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

• 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 areas 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 2 July 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 2 July 2019.

Background

Highfield Clinic is in Edgbaston, Birmingham and provides private treatment to adults and children. The practice is located on the first floor of a multi-occupancy building and can only be accessed by stairs. Car parking spaces are available in the practice car park at the rear of the building.

The dental team includes three dentists, three dental nurses, one dental hygiene therapist and one receptionist. The dental hygiene therapist is also the practice manager. The practice has two treatment rooms.

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 Highfield Clinic is the principal dentist.

During the inspection we spoke with the principal dentist and the dental hygiene therapist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday and Wednesday from 9am to 8pm, Tuesday and Thursday from 9am to 6pm, Friday from 9am to 5pm. The practice is also open on alternate Saturdays from 9am to 1pm.

Our key findings were:

Not all medical emergency equipment was available. The practice had purchased items identified as missing during the previous inspection. Upon checking equipment at this inspection it was identified that other items were missing, these items were ordered during this inspection.

Evidence was available to demonstrate that all staff had completed training regarding safeguarding vulnerable adults and children, basic life support and infection prevention and control. Evidence was available to demonstrate that the visiting sedationist had received update training regarding sedation.

The provider assured us that patients were no longer treated in areas other than a designated dental treatment room.

We saw cleaning schedules for the practice although these had not always been signed by the person undertaking the cleaning.

Emergency lighting had been subject to routine servicing and checks.

Evidence was available to demonstrate that a five-year fixed wiring test had been completed. A gas safety certificate was available.

Appropriate dispensing information was recorded on dispensing labels.

The practice had introduced an information governance system which ensured that policies and procedures contained a date of implementation and review.

The provider had recruitment files for each staff member which demonstrated that records relating to people employed included information relating to the requirements of Schedule 3 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

Risk assessments were available regarding all substances hazardous to health in use at the practice.

A practice health and safety risk assessment and fire assessment had been completed by an external professional.

The provider had obtained assurances that all clinical staff had immunity against vaccine preventable infectious diseases.

A system had been introduced for the on-going assessment, supervision and appraisal of all staff. Some improvements were required to the practice’s induction processes.

A legionella risk assessment had been completed by an external professional on 21 February 2020 and the practice were awaiting a copy of the risk assessment.

Improvements had been made to the practice's policies and procedures for obtaining patient consent to care and treatment. Capacity assessment forms were available for use as required.

Improvements had been made to the practice's complaint handling procedures and an accessible system for identifying, receiving, recording, handling and responding to complaints by service users had been introduced.

Some action had been taken to ensure the service takes into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

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.
• Take action to implement any recommendations in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’

We carried out this announced inspection on 2 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

Highfield Clinic is in Edgbaston, Birmingham and provides private treatment to adults and children.

The practice is located on the first floor of a multi-occupancy building and can only be accessed by stairs. Car parking spaces are available in the practice car park at the rear of the building.

The dental team includes three dentists, four dental nurses, including the practice manager, a dental hygiene therapist and two receptionists. The practice has two treatment rooms. The dentists who own and work at Highfield Clinic also own and work at a sister practice located in Wolverhampton.

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 Highfield Clinic is the principal dentist.

On the day of inspection we received feedback from 23 patients.

During the inspection we spoke with two dentists, one dental nurse, one dental hygiene therapist, a receptionist 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 9am to 7pm, Tuesday and Thursday 9am to 6pm, Wednesday 9am to 8pm, Friday 9am to 5pm. The practice is also open on alternate Saturdays from 9am to 1pm.

Our key findings were:

• The practice appeared clean and well maintained. Patients commented positively that the practice was always spotless, clean and comfortable.
• The provider had infection control procedures which reflected published guidance. We were sent evidence to demonstrate that the infection control lead completed training regarding infection prevention and control following this inspection.
• Evidence was not available on the premises to demonstrate that some staff had completed update training to deal with medical emergencies. Not all appropriate medicines and life-saving equipment were available. Missing items were purchased following this inspection.
• The provider had some systems to help them manage risks to patients and staff, but improvements were required.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Information was not on the premises to demonstrate that the provider had thorough staff recruitment procedures. Recruitment information was held off site by a human resources manager and was not available for review at this inspection. Prior to this inspection, the provider had been informed that recruitment and training records would be required for review.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• 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, although few responses had been received.
• Improvements could be made to the arrangements for ensuring good 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.

Full details of the regulation/s the provider is not meeting are at the end of this report.

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

• Take action to implement any recommendations in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’

• Improve and develop the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.

• Improve the practice's complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.

• Take action to ensure the service takes into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.