Archived: Dairyground Dental Practice

We undertook a follow-up focused inspection of Dairyground Dental Practice on 26 June 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 Dairyground Dental Practice on 3 October 2018 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, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We used our enforcement powers that required the provider to take action.

We carried out a follow-up inspection on 19 March 2019 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. We found that some improvements had been made, but further work was required to ensure that care was fully safe and well-led. The provider was required to take remedial action.

You can read our reports of these previous inspections by selecting the 'all reports' link for Dairyground Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked the following questions about care and treatment provided:

• 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 areas where improvement was required.

Our findings were:

Are services safe?

We found this practice was not providing safe care in accordance with the relevant regulations.

The provider had made some improvements in relation to the regulatory breaches we found at our inspections of 3 October 2018 and 19 March 2019. We found that systems and processes to support safe working were not embedded.

Are services well-led?

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

The provider had made some improvements in relation to the regulatory breaches we found at our inspections of 3 October 2018 and 19 March 2019 but had not done all that was necessary to meet the regulatory requirements.

Background

Dairyground Dental Practice is located in Bramhall, Stockport, Greater Manchester and provides NHS and some private treatment for adults and children.

The practice is not accessible for people who use wheelchairs and those with pushchairs due its access via a flight of stairs. Car parking spaces are available outside the practice, where the waiting time is limited to 90 minutes.

The dental team includes four dentists, two dental nurses, a locum dental nurse and a part-time receptionist. A practice manager works at the practice three days each week and also carries out reception duties. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist at a sister practice. 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 provider, two dentists, one dental nurse, the 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 from 8.30am to 1pm and from 2pm to 5.30pm Monday to Thursday. On Friday the practice is open from 8.30am to 1pm.

Our key findings were:

• Staff carrying out work in the decontamination room, were using appropriate personal protection equipment.
• Staff were still not examining manually cleaned instruments, before moving them to the autoclave be processed.
• We found recommendations for infection control were not embedded. We found two buckets of dirty water with mops in them, in the small decontamination room, close to the ‘clean area’, designated for packaging of dental instruments.
• Management of Legionella and practises to support this, were still not understood or executed, as per the practice risk assessment. The provider lacked oversight or understanding of this.

• Although all recruitment checks on permanent staff were now up to date, assurance of all checks on locum staff were not in place.
• Oversight of staff training had improved.
• Radiation protection information was in place, with local rules available to staff for reference. Evidence of servicing and safety checks on all radiation equipment was available.
• Arrangements for review of the fire risk assessment were in place. We saw evidence that work had been carried out on the electrics at the practice to ensure these met required standards.
• There was still no effective way for receipt, circulation, discussion and confirmation of understanding, of medical alerts and updates on clinical guidance.
• Communication across the practice, and between the and provider and staff, was not effective.
• Quality assurance processes required further work. Audits we were shown, did not contribute to learning and were not reviewed and analysed to drive improvement.
• A Statement of Purpose had still not been submitted to the Care Quality Commission.
• Leadership remained insufficient.

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.

We are taking regulatory action to impose conditions on the registration of the provider.

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

We undertook a follow-up inspection of Dairyground Dental Practice on 19 March 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 Dairyground Dental Practice on 4 October 2018 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, 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 Dairyground 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. We then inspect again after a reasonable interval, focusing on the areas where improvement is required.

Our findings were:

Are services safe?

We found this practice was not providing safe care in accordance with the relevant regulations.

The provider had made several improvements in relation to the regulatory breaches we found at our inspection on 4 October 2018 but these did not fully address the shortfalls identified.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations. The provider had made some improvements in relation to the regulatory breaches we found at our inspection on 4 October 2018 but these did not fully address the shortfalls identified.

Background

Dairyground Dental Practice is in the village of Bramhall, close to Stockport, Greater Manchester, and provides NHS and some private treatment for adults and children.

The practice is not accessible for people who use wheelchairs and those with pushchairs due its access via a flight of stairs. Car parking spaces are available outside the practice, where the waiting time is limited to 90 minutes.

The dental team includes four dentists, one employed dental nurse, a locum dental nurse and a part-time receptionist. A practice manager works at the practice three days each week and also carries out reception duties. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist at a sister practice. 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 one dentist, two dental nurses, the 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 from 8.30 to 1pm and from 2pm to 5.30pm Monday to Thursday. On Friday the practice is open from 8.30am to 1pm.

Our key findings were:

• The practice was visibly clean.

• There were some improvements in infection control procedures, but further work was required to ensure staff followed recognised guidance.

• There was a lack of oversight of work in the decontamination room; staff were not working in-line with recognised guidance.

• There was still no radiation protection file in place for staff to refer to. We found that recommended rectangular collimators were still not in use. The last service check on equipment, which is carried out every three years, had expired in 2017.

• Staff demonstrated that they understood their responsibilities for safeguarding vulnerable adults and children. All staff had received training to the required level and information on local area contacts was available to staff.

• We found records in relation to staff and recruitment were still incomplete.

• No changes had been made since our last inspection, in relation to protecting privacy of patients in particular, in relation to the mail received at the practice.

• Practice leadership had not improved. Staff were not fully supported when trying to bring about improvements required.

• There was no focus on improvement, for example, through audit.

• Improvements made in relation to information governance were insufficient.

We identified regulations the provider was not meeting. 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 that only fit and proper persons are employed.

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 practice’s responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

• Review staff awareness of the requirements of the Mental Capacity Act 2005 and Gillick competence, and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.

• Review the practice's protocols for medicines management including the prescribing of antibiotics to ensure this is in line with current guidance.