Burton Dental Lodge

We undertook a follow up focused inspection of Burton Dental Lodge on 7 November 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 supported by a specialist dental adviser.

We undertook a comprehensive inspection of Burton Dental Lodge on 26 June 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 and well led care and was in breach of regulations 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 Burton Dental Lodge 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. We then inspect again after a reasonable interval, focusing on the area 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 breach we found at our inspection on 26 June 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 breach we found at our inspection on 26 June 2019.

Background

Burton Dental Lodge is in Boston in Lincolnshire. The practice provides private dental treatment to adults and children.

There is level access through the automatic sliding front door. The practice has two treatment rooms, both located on the ground floor.

The dental team includes one dentist, one dental hygienist, one part-time anaesthetist, and four dental nurses.

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 Burton Dental Lodge is the principal dentist.

During the inspection we spoke with the practice owner. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Saturday: from 9am to 5.30pm.

Our key findings were:

• Improvements had been made to dental care records relating to sedation, and important information such as the patient’s name, date of birth and weight were being recorded.
• Emergency medicines and life-saving equipment were in line with Resuscitation Council UK standards.
• Medicines used in sedation were in date and were being checked regularly.
• Risk assessments relating to the control of substances hazardous to health (COSHH) had been completed.
• A new gas safety certificate had been issued on 15 July 2019.
• Improvements had been made to the quality assurance systems including completing regular audit cycles of radiography, dental care records and infection prevention and control.
• The practice had made arrangements to receive and respond to patient safety alerts issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System, and Public Health England.
• A duty of candour policy had been introduced and staff awareness raised.
• Several policies had been re-written and were personalised to the practice.

The provider had also made further improvements:

• Improvements had been made to the consent policy to include information relating to the Mental Capacity Act, best interest decisions and Gillick competence.
• The practice had a certificate from the Health and Safety Executive in line with the Ionising Radiation Regulations (IRR17).

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

• Take action to ensure dentists are aware of the guidelines issued by the British Endodontic Society for the use of dental dam for root canal treatment.

• Take action to ensure that conscious sedation undertaken at the practice takes into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry and 'Standards for Conscious Sedation in the Provision of Dental Care 2015'. In particular review multidrug sedation in that it should be used on a case by case basis and the justification recorded within the patents dental care records review consent for sedation patients to allow this to be gained on a different day to having sedation unless in an emergency.

We carried out this announced inspection on 26 June 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

Burton Dental Lodge is in Boston in Lincolnshire. The practice provides private dental treatment to adults and children.

There is level access through the automatic sliding front door. The practice has two treatment rooms, both located on the ground floor.

The dental team includes one dentist, one dental hygienist, one part-time anaesthetist, and four dental nurses.

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 Burton Dental Lodge is the principal dentist.

On the day of inspection, we collected 15 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, and four dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Saturday: from 9am to 5.30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. Six-monthly audits of infection prevention and control had not been completed.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Records did not demonstrate that staff were checking these regularly to ensure they were available, within their expiry date, and in working order.
• The provider was not following guidelines issued by the British Endodontic Society in respect of the use of rubber dams.
• The provider did not have a system for receiving and responding to patient safety alerts, issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.
• The provider did not have risk assessments for the control of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider was not following national guidance when delivering domiciliary care.
• The provider had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Records relating to sedation were not always fully completed.
• The provider had not registered with the Health and Safety Executive in respect of the Ionising Radiation Regulations (IRR17)
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff provided preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider did not demonstrate effective leadership or a culture of continuous improvement.
• The provider dealt with complaints positively and efficiently.

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 regulations the provider was/is not meeting are at the end of this report.

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

• Review the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are following legislation, take into account relevant guidance, and staff follow them. Particularly in respect of the Mental Capacity Act (2005) and best interest decisions, and Gillick competencies.

• Review the practice’s registration with the health and safety executive in relation to radiography in line with the updated Ionising Radiation Regulations (IRR17) in 2017.

• Review the practice's protocols for medicines management and ensure antibiotic prescribing is audited annually in line with current guidelines.