The Barn Cosmetic and Dental Clinic

We undertook a follow up desk-based inspection of The Barn Cosmetic and Dental Clinic on 14 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.

We undertook a comprehensive inspection of The Barn Cosmetic and Dental Clinic on 24 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 well led care and was in breach of regulation 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 The Barn Cosmetic and Dental Clinic on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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 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 24 July 2019.

Background

The Barn Cosmetic and Dental Clinic is in Odstock, Salisbury and provides private treatment for adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available at the practice.

The dental team includes the principal dentist, two other dentists, two dental nurses, one dental hygienist, one receptionist and the practice manager. The practice has two treatment rooms.

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 The Barn Cosmetic and Dental Clinic is the practice manager.

During the inspection we spoke with the practice manager. We were sent evidence of practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday to Friday from 8.30am to 5pm.

Our key findings were:

• The practice had made significant improvement and had ensured that they had established and effective systems and processes which ensured good governance in accordance with the fundamental standards of care.

We undertook a follow up focused inspection of The Barn Cosmetic and Dental Clinic on 24 July 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 The Barn Cosmetic and Dental Clinic on 13 March 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 (Safe care and treatment), 17 (Good governance) and 19 (Fit and proper persons employed) 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 The Barn Cosmetic and Dental Clinic 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 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 13 March 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 in relation to the regulatory breaches we found at our inspection on 13 March 2019.

Background

The Barn Cosmetic and Dental Clinic is in Odstock, Salisbury and provides private treatment for adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available at the practice.

The dental team includes the principal dentist, two other dentists, two dental nurses, one dental hygienist, one receptionist and the practice manager. The practice has two treatment rooms.

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 The Barn Cosmetic and Dental Clinic is the practice manager.

During the inspection we spoke with the principal dentist, one dental nurse 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 to Friday from 8.30am to 5pm.

Our key findings were:

• The practice carried out all the necessary tests required to check that the ultrasonic cleaner was working effectively.
• Staff were following the manufacturer’s instructions in respect of single use healing abutments.
• The implant kit was appropriately stored.
• Results of the Radiography and Infection Prevention and Control audits had been analysed and there were associated action plans. The practice had ensured these audits were in the diary in order to be undertaken at the appropriate frequency.
• Fire alarm and emergency lighting tests were carried out as required.
• The fire safety risk assessment recommended actions had been completed with the exception of one recommendation. The provider was working with a different fire risk assessor to ensure all identified risks were mitigated.
• Insufficient improvements had been made in relation to the practice’s recruitment procedures.
• A sharps risk assessment had been carried out; however, we noted that neither this document or the sharps policy provided clear guidance for staff for disposing of sharps.
• Improvements were required in relation to the practice's protocols for medicines management and storage.
• No action had been taken to improve 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. Specifically, in respect of the section which lists possible consequences of not having dental implant treatment.

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 are at the end of this report.

We carried out this announced inspection on 13 March 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

The Barn Cosmetic and Dental Clinic is in Odstock, Wiltshire and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available at the practice.

The dental team includes the principal dentist, a visiting dentist, two dental nurses, one dental hygienist, one receptionist and a practice manager. The practice has two treatment rooms.

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 The Barn Cosmetic and Dental Clinic is the practice manager.

On the day of inspection, we collected 32 CQC comment cards filled in by patients and obtained the views of four other patients.

During the inspection we spoke with the principal dentist, the 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 Monday to Friday from 8.30am to 5pm.

Our key findings were:

• The practice appeared clean.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• 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 were providing preventive care and supporting 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 practice dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.
• The practice’s recruitment procedures were not thorough.
• The practice had systems to help them manage risk to patients and staff. This required improved management, governance and oversight.
• The practice’s systems did not effectively enable the registered person to assess, monitor and improve the quality and safety of the services being provided. Audits undertaken did not have associated action plans.
• Recommended actions resulting from undertaken risk assessments had not been completed.
• The practice’s infection control procedures did not fully reflect published guidance. Improvements were required to ensure the equipment used by staff for cleaning and sterilising instruments was validated, maintained and used in line with the manufacturers’ guidance.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure the equipment being used to care for and treat service users is safe for use.
• 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.
• Ensure specified information is available regarding each person 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 medicines management and ensure all medicines are stored and dispensed of safely and securely.
• Review the suitability of the premises and ensure all areas are fit for the purpose for which they are being used.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the practice’s arrangements for ensuring good governance and leadership are sustained in the longer term.
• Review 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.