Church Street Dental Care

We undertook a follow up focused inspection of Church Street Dental Care on 21 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 follow up focused inspection of Church Street Dental Care on 16 September 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 effective or well led care and was in breach of regulation 9 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 Church Street Dental Care on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it effective?

• Is it well-led?

Our findings were:

Are services effective?

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

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Church Street Dental Care is in Littleborough, Lancashire and provides private treatment for adults and children.

There is single step access into the practice. Car parking is available near the practice on local side streets.

The dental team includes the principal dentist, four dental nurses and one dental hygienist. The practice has two 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 principal dentist and two dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday by appointment only.

Tuesday 10am to 7:30pm, Wednesday 10am to 2:30pm, Thursday 9am to 5pm and Friday 8am to 4pm.

Our key findings were:

• The provider could demonstrate they more closely followed guidance in respect to the completion of patient dental care records. Further improvements could be made.
• Systems were in place to ensure the provider remained up to date with relevant professional guidance.
• The provider was able to demonstrate their intention to integrate the use of dental dams.
• Recruitment procedures were in line with relevant legislation.
• Safer sharps systems were in line with current regulations.
• Improvements could be made to ensure clarity when reporting on X-rays taken.
• A system was in place to respond to relevant patient safety alerts.
• Control measures were in place for the use of the Orthopantomogram (OPG) and these reflected current regulations.
• Leadership and oversight of governance systems were improved.
• Systems to assess, monitor and improve the quality and safety of the service were more effectively managed.

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

• Take action to ensure the clinicians take into account the guidance provided by the Faculty of General Dental Practice when completing dental care records.
• Take action to ensure clinicians report on the findings and the quality of the X-ray image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.

We undertook a focused inspection of Church Street Dental Care on 16 September 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 Church Street Dental Care on 5 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, effective or well led care and was in breach of regulation 9,12,17 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 Church Street Dental Care on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it effective?

• 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 (requirement notice only). 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 5 March 2019.

Are services effective?

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

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 5 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 to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 5 March 2019.

Background

Church Street Dental Care is in Littleborough, Lancashire and provides private treatment for adults and children.

There is single step access into the practice. Car parking is available near the practice on local side streets.

The dental team includes the principal dentist, four dental nurses and one dental hygienist. The practice has two 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 principal dentist and a dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday by appointment only.

Tuesday 10am to 7:30pm, Wednesday 10am to 2:30pm, Thursday 9am to 5pm and Friday 8am to 4pm.

Our key findings were:

• Infection control processes were now in line with relevant guidance.
• Improvements had been made to staff recruitment procedures. Further improvement was required to ensure that the process was fully in line with relevant legislation.
• The management of medicines was now effective and met current regulations.
• Further improvements could be made to ensure the provider is up to date with national guidance and is meeting quality standards.
• Further improvements could be made to ensure clarity when reporting on X-rays taken.
• The level of detail recorded in the patient dental care records had improved but needed further attention.
• The medical emergency kit now reflected recognised guidance and the system to monitor the kit was effective.
• The provider was not using dental dams to protect the patient’s airway during root canal treatment.
• Improvements could be made to ensure action taken in response to a patient safety alerts were recorded for future reference.
• Safe sharps systems had been improved but were not fully in line with current regulations.
• Recommendations identified in the disability access audit and the fire risk assessment were now complete.
• Further action could be taken to improve control measures when using the Orthopantomogram (OPG) in line with current regulations.
• Systems to assess, monitor and improve the quality and safety of the service were now more effectively managed.
• Leadership and oversight of governance systems and processes could be improved.

We identified regulations the provider was not meeting. They must:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was not meeting are at the end of this report.

We carried out this announced inspection on 5 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 not 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

Church Street Dental Care is in Littleborough, Lancashire and provides private treatment for adults and children.

There is single step access into the practice. Car parking is available near the practice on local side streets.

The dental team includes the principal dentist, four dental nurses (one of whom is a trainee) and one dental hygienist. The practice has two 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.

On the day of inspection, we collected 14 CQC comment cards filled in by patients. All comments received were complimentary about the service being provided.

During the inspection we spoke with the principal dentist, two dental nurses and the dental hygienist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday by appointment only.

Tuesday 10am to 7:30pm, Wednesday 10am to 2:30pm, Thursday 9am to 5pm and Friday 8am to 4pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which could be brought fully in line with guidance.
• Staff knew how to deal with emergencies. The management of the medical emergency kit was not in line with recommended guidance.
• The practice had systems to help them manage risk but improvement was needed.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider’s recruitment procedures could be improved.
• Improvement was required to systems in place to confirm staff immunity.
• Clinical awareness of the National Institute for Clinical Excellence (NICE) and The Faculty of GeneralDental Practice UK (FGDP (UK) was not embedded.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Improvements could be made to delivering preventive care and support to patients to ensure better oral health in line with recommended guidance.
• The appointment system took account of patients’ needs.
• Some areas of leading the practice and managing systems and processes could be improved.
• The practice’s systems for continuous improvement were not effective.
• 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 provider had systems to deal with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 systems for environmental cleaning taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices. In particular: the storage of mops.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account guidance issued by the National Institute for Clinical Excellence (NICE).
• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment. In particular: register the use of X-ray equipment as required, with the Health and Safety Executive.