Signature Smiles Dental Practice

We undertook a focused inspection of Signature Smiles Dental Practice on 27 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 who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Signature Smiles Dental Practice on 7 August 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 or 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 Signature Smiles Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?
• 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 breach we found at our inspection on 7 August 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 7 August 2019.

Background

Signature Smiles Dental Practice is in Gobowen, Shropshire and provides NHS treatment for adults and children. The practice is one of two within Shropshire registered under the same provider.

There is ramped access for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for people with disabilities, are available near the practice.

The dental team includes six dentists, four dental nurses including three trainee dental nurses and a practice manager. The practice has three treatment rooms and centralised decontamination facilities.

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 one dentist, an area manager 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 5.30pm.

Our key findings were:

• Emergency medicines and equipment were as described in the Resuscitation Council UK’s national guidance.
• Infection prevention and control audits had been completed on a six-monthly basis in line with national guidance.
• The infection control lead had completed additional training to support their role.
• The practice had a system for receiving alerts from the Medicines and Healthcare products Regulatory Agency and Central Alerting System.
• The practice had a whistleblowing (speak up) policy and this was available to all staff.
• The practice had a system for recording accidents and significant events. This was being reviewed and updated at the time of this inspection.
• All staff had received a formal appraisal of their performance in the 12 months leading up to this inspection. Dentists had completed personal development plans in line with requirements from the General Dental Council.
• Radiography audits had been completed for dentists in the 2 months leading up to this inspection.
• Safeguarding protocols were in place to reduce risk and help keep patients safe.
• Information held at the practice relating to the Control of Substances Hazardous to Health had been updated.
• Staff files demonstrated all clinical staff had received inoculations to protect them from the Hepatitis B virus, and their level of immunity was recorded within their personnel file.

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

• Implement an effective system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.

We carried out this unannounced focused inspection on 7 August 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 and an inspection manager.

To get to the heart of patients’ experiences of care and treatment, we asked the following two questions:

• Is it safe?

• 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 well-led?

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

Background

Signature Smiles is in Gobowen, Shropshire and provides NHS treatment to adults and children.

There is ramp access for people who use wheelchairs and those with pushchairs. Car parking is not available on site, however there is a public car park across the road from the surgery. There are no dedicated parking spaces for blue badge holders.

The dental team includes 3 dentists, 4 trainee dental nurses and 1 receptionist. The practice has 3 treatment rooms.

The practice is owned by an individual. 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, three trainee dental nurses, one company director and the area manager. The registered manager was unavailable on the day of inspection. We looked at practice policies and procedures and other records about how the service is managed.

The practice was open: Monday to Friday 8.30am to 5.30pm.

Our key findings were:

• The clinical staff provided patients’ care and treatment in line with current guidelines.
• We saw that staff treated patients with dignity and respect.
• Staff worked well as a team.
• The practice did not appear clean and well maintained throughout.
• There were a lack of systems and processes to ensure staff had full awareness of their responsibilities in relation to the duty of candour which was not in compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• The provider did not have adequate systems in place to help them manage risk to patients and staff.
• Governance arrangements required significant review and strengthening.

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 is not meeting are at the end of this report.

There were areas where the provider could make improvements.

They should:

• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.

• Review the practice’s sharps procedures to ensure the practice is complying with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013

• Review the practice’s recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff