Updated 31 January 2018
We carried out this announced inspection on 20 December 2017 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.
We told the NHS England area team and they provide provided information which we took into account.
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
Firs dental surgery is in Caterham and provides NHS treatment to patients of all ages.
There is no level access for people who use wheelchairs and pushchairs. However there is an entrance at the rear of the building that had a small step which might be accessible. This entrance has direct access from the small car parking area. Car parking spaces are available near the practice. There are no disabled toilet facilities.
The dental team includes 4 dentists, 2 dental nurses, 1 dental hygienist, 1 dental nurse trainee and 2 receptionists. The practice has 3 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 17 CQC comment cards filled in by patients and spoke with 1 other patient. This information gave us a positive view of the practice.
During the inspection we spoke with 2 dentists, 1 dental nurse, 1 trainee dental nurse and 1 receptionist. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday to Thursday 08.30 to 17.00 closed for lunch 13.00 to 14.00
Friday 08.30 to 16.00 closed for lunch 13.00 to 14.00
Saturday and Sunday Closed
Our key findings were:
- The practice had some infection control procedures which reflected some of the published guidance.
- Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The practice had some systems to help them manage risk.
- The practice had suitable safeguarding processes; however staff were less confident with their responsibilities for safeguarding adults and children.
- The practice did not appear to be clean and well maintained.
- The practice did not have thorough staff recruitment procedures.
- 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.
- The appointment system met patients’ needs.
- The practice did not have effective leadership. Staff felt involved and supported and worked well as a team.
- The practice asked staff and patients for feedback about the services they provided.
- The practice dealt with complaints positively and efficiently.
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.
- 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 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 arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE)
- Review staff training to ensure that all of the staff had undergone relevant training, to an appropriate level, in the Mental Capacity Act,
- Review the practice's protocol and staff awareness of their responsibilities under the Duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
- Review the analysis of the grades for the quality of radiographs to ensure these are correctly recorded over each audit cycle and for each dentist.
- Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
- Review the practice’s policies to ensure all documents are providing the latest requirements and guidance.
- Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
- Review availability of an interpreter services for patients who do not speak English as a first language.
- Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
- Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and patients notes are undertaken at regular intervals to help improve the quality of service. Practice should also ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
- Review the storage of prescriptions and monitor in line with NHS guidance.
- Review the way staff are supported to make sure that staff are able to meet the requirements of the relevant professional regulator throughout their employment, such as requirements for continuing professional development.
- Consider reviewing the information held on the practice website and NHS choices regarding accessibility of the practice.
- Introduce protocols regarding the prescribing and recording of antibiotic medicines taking into account guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.