The Care Quality Commission
  • Dentist
  • Dentist

The Crescent Dental Practice

135b Queens Drive, Liverpool, Merseyside, L13 0AB (0151) 708 5157

Provided and run by:
Dr Shing Alexander Chu

All Inspections

21 September 2021

During an inspection looking at part of the service

We undertook a follow-up focused inspection of The Crescent Dental Practice. 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 following our visit to the practice on 7 July 2021.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of The Crescent Dental Practice on 8 June 2021 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, effective or well- led care and was in breach of regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In response to our findings, we took urgent enforcement action, closing the practice for a period of 28 days during which the provider was required to make improvements. We revisited the practice on 7 July 2021 to check on improvements made. We found that sufficient improvements had been made to allow the practice to open again from Monday 12 July 2021. There were some areas that required further improvement and we set these out in our report from that inspection, published on 27 July 2021.

You can read our reports of these inspections by selecting the 'all reports' link for The Crescent Dental Practice 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 areas 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 7 July 2021.

Background

The Crescent Dental Practice is in the West Derby area of Liverpool and provides largely NHS treatment for adults and children. Some private treatment is available.

There is level access to the practice for people who use wheelchairs and those with pushchairs. There is some car parking available outside the practice.

The dental team includes seven dentists, four qualified dental nurses, six trainee dental nurses, one dental hygiene therapist, a practice administrator and a practice manager. The practice has five treatment rooms.

The practice is owned by an individual who is the principal dentist there. 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 practice owner, two dental nurses, staff working in reception, the practice administrator and the practice manager.

The practice is open from Monday to Friday 9.30am to 5.30pm.

Our key findings were:

  • Staff were following recommended guidance in respect of Infection prevention and control. Processes and procedures had been introduced to uphold standards of infection control and staff had received training on the related

‘Health Technical Memorandum 01-05 (HTM01-05) Decontamination in primary dental care services’. Validation checks on equipment used to clean dental instruments were being undertaken as required and records of this were in place.

  • Our observation of dental nurses working in the decontamination room indicated that further training was required on the provision of HTM01-05.
  • Needlestick injury posters were in place around the practice. These had the contact details of local occupational health services, for use in the event of injury.
  • Emergency medicines and equipment, (including the recommended volume of medical oxygen) were available as described in recognised guidance. Daily checks on all medical emergency equipment and medicines were in place and we found these to be effective.
  • The complaint handling policy and procedure had been updated to reflect recognised guidance on handling complaints and concerns in the NHS.
  • A system was in place to provide oversight of staff training and continuing professional development (CPD).
  • All required recruitment checks were in place for staff. One of the staff background checks required further follow-up.
  • The required check on staff levels of immunity to blood borne diseases, for example, Hepatitis B, had been carried out and records of these held. Further follow-up was required for one staff member.
  • The provider had adapted the appointment booking system in order to effectively support safe flow of patients through the practice in a way that upheld COVID security. Our review of dental care and treatment records showed that not all clinicians were recording their observance of required fallow times between patient treatments.

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

  • Take action to ensure the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular that the decontamination room is developed and improved to meet the requirements of the size of the practice.
  • Take action to ensure audits, for example of dental treatment records and infection prevention and control are undertaken at regular intervals to improve the quality of the service. The provider should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
  • Take action to ensure the practice stores records relating to people employed and the management of regulated activities in compliance with legislation and take into account current guidance. Particularly, that where staff have failed to supply required evidence of checks, that these are followed up.

07 July 2021

During an inspection looking at part of the service

We undertook a focused, follow-up inspection of The Crescent Dental Practice on 7 July 2021. 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, following our visit and inspection of the practice on 8 June 2021.

The inspection was led by a CQC inspector who was supported by a second CQC inspector and a specialist dental adviser.

We undertook a comprehensive inspection of The Crescent Dental Practice on 8 June 2021 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, effective or well led care and was in breach of Regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection of 8 June 2021, we took urgent enforcement action, suspending the provider registration and closing the practice for 28 days. You can read our report of that inspection by selecting the 'all reports' link for The Crescent Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it effective?

• Is it well-led?

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 8 June 2021.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 8 June 2021.

Are services well-led?

We found this practice was not 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 8 June 2021. However, there were some areas were further action was still required.

Background

The Crescent Dental Practice is located in North Liverpool and provides largely NHS dental care and treatment for adults and children. Some private dental care and treatment is also available.

There is level access to the practice for people who use wheelchairs and those with pushchairs. There is some car parking available outside the practice.

The dental team includes seven dentists, four qualified dental nurses, six trainee dental nurses, one dental hygiene therapist, a practice administrator and a practice manager. The practice has five treatment rooms.

The practice is owned by an individual who is the principal dentist there. 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 practice owner, two dental nurses, staff working in reception, the practice administrator and the practice manager.

The practice is open from Monday to Friday 9.30am to 5.30pm.

Our key findings were:

  • Staff were following recommended guidance in respect of Infection prevention and control. Processes and procedures had been introduced to uphold standards of infection control and staff had received training on the related Health Technical Memorandum.
  • Emergency medicines and equipment were available as described in recognised guidance. Additional medical oxygen cylinders were purchased on the day of inspection.
  • The majority of policies and procedures had been updated and gave the correct contact details of relevant organisations. Some required further update; the complaint handling procedure did not reflect recognised guidance on handling complaints and concerns in the NHS.
  • The majority of staff had received training and updates relevant to their roles, for example, safeguarding training and infection prevention and control training. Records to support this were available for inspection. Further action was required to ensure all staff were appropriately trained.
  • All required recruitment checks were now in place for all staff.
  • Staff had received training on systems and processes to help manage risks to patients and staff; staff were comfortable when asked to explain these processes.
  • Safety devices for use when treating patients were available in all treatment rooms.
  • Governance around essential safety checks was in place, for example, for the annual gas safety check, the five-year fixed electrical wiring check and Legionella checks
  • The provider was working to adapt the appointment booking system in order to effectively support safe flow of patients through the practice in a way that upheld COVID security. These changes had not yet been implemented.

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

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

  • Take action to ensure the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular that the decontamination room is developed and improved to meet the requirements of the size of the practice.

8 June 2021

During an inspection looking at part of the service

We carried out this announced inspection on 8 June 2021 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 Care Quality Commission, (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 three questions:

• Is it safe?

• Is it effective?

• Is it well-led?

These questions form the framework for the areas we looked at during the inspection.

Our findings were:

Are services safe?

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

Are services effective?

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

Are services well-led?

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

Background

The Crescent Dental Practice is located in North Liverpool and provides largely NHS dental care and treatment for adults and children. Some private dental care and treatment is also available.

There is level access to the practice for people who use wheelchairs and those with pushchairs. There is some car parking available outside the practice.

The dental team includes seven dentists, four qualified dental nurses, six trainee dental nurses, one dental hygiene therapist, a practice administrator and a practice manager. The practice has five treatment rooms.

The practice is owned by an individual who is the principal dentist there. 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 two dentists, two dental nurses, one staff member working in reception, the practice administrator 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 Monday to Friday 9.30am to 5.30pm.

Our key findings were:

  • The provider had infection control procedures in place, however, these were not being consistently adhered to by all staff.
  • Appropriate medicines and life-saving equipment were not available, as required and as described in recognised guidance. Although staff had received training on how to deal with emergencies, they had failed to identify that pieces of emergency kit were missing.
  • We found in some areas, the provider’s systems to help them manage risk to patients and staff were not being followed.
  • The provider safeguarding policies and processes required updating; staff knew their responsibilities for safeguarding vulnerable adults and children but systems to support this required improvement.
  • The provider had staff recruitment procedures in place. These did not reflect current legislation.
  • The clinical staff provided patients’ care and treatment in line with current guidelines. We observed that not all dentists used techniques that support patient safety in some procedures, for example, use of rubber dam.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • Staff provided preventive care and supported patients to ensure better oral health.
  • Although the appointment system took account of patients’ needs, we found it did not follow guidance for management of dental treatment rooms in the context of COVID.
  • There had been changes to leadership at the practice. New arrangements were in place but were not fully embedded.
  • The provider had information governance arrangements and staff were aware of these.

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 persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.