Digmoor Dental Practice

We carried out this announced inspection on 24 January 2020 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 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

Digmoor Dental Practice is in a residential suburb of Skelmersdale. The practice provides NHS and private dental care for adults and children.

There is level access to the practice for people who use wheelchairs and for people with pushchairs.

Car parking, including for people with disabilities, is available outside the practice.

The dental team includes two dentists, a dental hygiene therapist, four dental nurses, two of whom are trainees, and one receptionist. The dental team is supported by a practice manager and assistant 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 Digmoor Dental Practice is the practice manager.

On the day of the inspection, we collected 41 CQC comment cards.

During the inspection we spoke to a dentist, the dental hygiene therapist, dental nurses, receptionists 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 Thursday 9.00am to 5.00pm

Friday 9.00am to 4.00pm.

Our key findings were:

• The practice was visibly clean.
• The practice had infection control procedures in place which staff followed. These did not take account of some aspects of current guidance.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• Staff knew how to deal with medical emergencies. Appropriate medicines and equipment were available.
• The provider had staff recruitment procedures in place. These were not consistently followed.
• Staff provided patients’ care and treatment in line with guidance.
• The dental team provided preventive care and supported patients to achieve better oral health.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for handling complaints. The practice dealt with complaints positively and efficiently.
• The practice had a leadership and management structure.
• The provider had systems in place to manage risk. Oversight of risk was not effective.
• Staff felt involved and supported and worked as a team.
• The provider had systems to support the management and delivery of the service, to support governance and to guide staff. Several of these systems were not operating effectively.
• The practice asked patients and staff for feedback about the services they provided.

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 specified information is available regarding each person 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:

• Improve the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Take action to ensure audits of radiography and infection prevention and control are undertaken at regular intervals to improve the quality of the service. Staff should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Take action to ensure the use of X-ray equipment on the premises is registered with the Health and Safety Executive.