The Care Quality Commission
  • Dentist
  • Dentist

Victoria Dental & Healthcare

Overall: Good read more about inspection ratings

109 Corporation Street, Manchester, Lancashire, M4 4DX (0161) 832 4153

Provided and run by:
Victoria Dental & Healthcare Limited

All Inspections

2 April 2020

During an inspection looking at part of the service

This service is rated as Good overall.   (Previous inspection 29/07/2019)

Victoria Dental & Healthcare Limited provides private dental and medical health care services.

This inspection relates to the medical health care services only.

Victoria Dental & Healthcare Limited offer private fee-based appointments to patients with registered medical doctors. The healthcare specialities offered by the service include gynaecology, general medicine, dermatology and psychiatry. Many of the patients that use the service are Polish and the medical doctors are also Polish.

Mrs Maria Kucharska-Piotrowicz is the registered manager (and a registered dentist). A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We previously inspected the medical health part of the service provided by Victoria Dental & Healthcare Limited in October 2017 and August 2018. The full comprehensive reports for these inspections, the inspection in July 2019 and the inspection report for the dental service (October 2017) can be found by selecting the ‘all services’ link for Victoria Dental & Healthcare Limited on our website at .

At our inspection in July 2019 we rated the practice as good overall, but requires improvement for providing safe services because:

  • Records did not demonstrate appropriate recruitment checks for clinicians had been consistently undertaken.

We issued a requirement notice for regulation 19 Fit and proper persons employed (Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). We also indicated improvements should be made as follows:

  • Improve written documentation so that confirmation of parental identification is consistently recorded.
  • Records translated from Polish, such as significant events, should reflect all the details of the incident such as the date of the incident and the date action was taken.
  • Strengthen the sharing of alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA) with the medical doctors by forwarding to them the monthly MHRA ‘Drug Safety Update’.
  • Implement the planned improvement to patient records by introducing an electronic patient record system.

On 2 April 2020, we carried out a focused, desk-based review of the safe key question. We reviewed evidence submitted by the service to confirm it had carried out the plan to meet the legal requirements in relation to the breach of regulation 19 identified at our inspection on 29 July 2019. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

At this inspection, we found that the provider had satisfactorily addressed all legal requirements and were implementing action as appropriate in response to the suggestion for improvements.

We have rated this practice as good for providing safe services.

We found that:

  • The service had reviewed and updated its recruitment records for all clinicians working in medical part of the service. We saw evidence that Disclosure and Barring Service (DBS) checks had been obtained immediately after the last inspection in July 2019 for the clinicians. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). In addition other evidence supplied by the provider demonstrated past working history, evidence of conduct in previous employment and staff identification records had been obtained for each person working within the medical service provision.
  • The provider supplied other evidence to show how they had taken action to improve the service in other areas. For example:
  • A copy of the service Parental Responsibility policy and procedure was provided with some anonymised examples where parents had signed consent forms and checks of the child’s identification had been confirmed by the service.
  • Records of recent significant events were recorded in English and these were dated.
  • Emails from between November 2019 and March 2020 demonstrated that the provider shared MHRA drug safety alerts with the clinicians who worked on a sessional basis at the service.
  • The provider confirmed that the team were in the process of uploading paper medical records into an electronic record system.

29 July 2019

During a routine inspection

This service is rated as Good overall. (Previous inspection 02/08/2018)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

Victoria Dental & Healthcare Limited provides private dental and medical health care services.

This inspection relates to the medical health care services only.

We previously inspected the medical health section of the service provided by Victoria Dental & Healthcare Limited in October 2017 and August 2018. The full comprehensive reports for these inspections and the inspection report for the dental service (October 2017) can be found by selecting the ‘all services’ link for Victoria Dental & Healthcare Limited on our website at www.cqc.org.uk.

We carried out this announced comprehensive inspection at Victoria Dental & Healthcare Limited on 29 July 2019. The purpose of this inspection was to investigate some anonymous allegations regarding medical practices; and in accordance with our updated methodology to inspect all key questions and provide a quality rating for the medical services provided.

Victoria Dental & Healthcare Limited offer private fee-based appointments to patients with registered medical doctors. The healthcare specialities offered by the service include gynaecology, general medicine, dermatology and psychiatry. Many of the patients that use the service are Polish and the medical doctors are also Polish.

Mrs Maria Kucharska-Piotrowicz is the registered manager (and a registered dentist). A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of our inspection we also asked for CQC comment cards to be completed by patients prior to our inspection. We received 16 completed comment cards (plus two completed internal patient feedback forms) where people who used the service shared their views and experiences of the service. All comments received were positive about the service.

Our key findings were:

  • We could find no evidence to substantiate the anonymous allegations reported to the CQC. For example, all medical doctors working for the service were appropriately trained, registered with the General Medical Council and had licences to practice in the UK. Medicines were prescribed correctly to patients and in accordance with guidance; systems to ensure blood test results were shared with the patient and their NHS GP (if consent was received) were established and the nurse working at the service was registered with the Nursing and Midwifery Council (NMC).
  • The service had systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes. However, some recruitment records required improvement.
  • The service reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
  • Appropriate medical records were maintained, although these were hand written.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Patients could access care and treatment from the service within an appropriate timescale for their needs.
  • There was a focus on continuous learning and improvement at all levels of the organisation. The registered manager had acted in response to areas we recommended should be improved at the last inspection. This included strengthening the service response to patient refusal for further tests and investigations, ensuring records logs of test results were maintained and patients notified, and improving consistency to ensure as far as possible the patients’ NHS GP was informed of test results and the implementation of a protocol to ensure parental identity was confirmed.
  • Management oversight of staff training, professional registration and annual appraisal was established
  • Information about services and how to complain was available. We found the systems and processes in place to manage and investigate complaints were effective.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure specified information is available regarding each person employed.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Improve written documentation so that confirmation of parental identification is consistently recorded.
  • Records translated from Polish, such as significant events, should reflect all the details of the incident such as the date of the incident, the date action was taken.
  • Strengthen the sharing of alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA) with the medical doctors by forwarding to them the monthly MHRA ‘Drug Safety Update’.
  • Implement the planned improvement to patient records by introducing an electronic patient record system.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

2 August 2018

During a routine inspection

We carried out an announced comprehensive inspection on 2 August 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the medical service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The CQC previously inspected Victoria Dental & Healthcare Limited (known as Victoria Clinic) on 26 October 2017 and asked the provider to make improvements of the medical service. The registered provider had failed to ensure safe services were delivered, systems to monitor and support medical doctors were not established and effective systems of governance were not in place. We issued one warning notice in respect of Good governance; Regulation 17 HSCA (RA) Regulations 2014 and one requirement notice in respect of Safe care and treatment; Regulation 12 HSCA (RA) Regulations 2014.

The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Victoria Dental & Healthcare Limited on our website at www.cqc.org.uk

The inspection of the dental service, was undertaken at the same time on 26 October 2017, and we found it to be meeting the regulations.

We carried out this follow up comprehensive inspection to the medical service on 2 August 2018 to confirm that the registered provider had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection of 26 October 2017. This inspection visit identified improvements had been made in service delivery for key questions Safe, Effective and Well Led.

Our key findings were:

  • Since the last inspection the registered manager had taken action and implemented governance systems to monitor and review clinical practice. This included clinical support and staff development.
  • Action had been taken to improve the quality of handwritten patients’ medical records.
  • Training certificates demonstrated doctors were trained to the appropriate children’s safeguarding level.
  • The system for recording and sharing learning from significant events was established and this was supported by a significant event policy and procedure.
  • The system for communicating and acting on patient safety alerts was established and action taken as required.
  • Meeting minutes showed the doctors employed by the service had attended team meetings. The minutes showed these meeting to be a forum to share learning.
  • The registered manager obtained advice and support from clinicians to improve clinical governance of the service.
  • Information about services, fees and how to complain was available.
  • Infection control arrangements were good. The premises were clean, tidy and fit for purpose.
  • Medicines and equipment for dealing with medical emergencies were available and an effective system was in place to monitor their use and expiration dates.
  • Systems to ensure appropriate follow up for abnormal blood and other test results were in place but these required strengthening.
  • The registered manager had implemented systems to ensure doctors did not dispense medicines brought from outside the UK.

There were areas where the provider could make improvements and should:

  • Review and develop the procedure to provide a safe and consistent framework for doctors to respond to a patient’s refusal for further tests and investigations.
  • Review the system of responding to abnormal test results by consistently recording the date feedback was provided to the patient.
  • Review the policy for notifying the patient’s GP of treatment, changing the options to an automatic opt in agreement unless specifically requested to the contrary by the patient.
  • Review and develop further, a programme of continuous quality improvement activity.
  • Review, formalise and record systems of patient identification including parental responsibility.

26 October 2017

During a routine inspection

We carried out an announced inspection on 26 October 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check on concerns we had received and whether the registered provider was meeting the legal requirements within the Health and Social Care Act 2008 and associated regulations.

This was a joint dental and medical inspection of an independent healthcare service. This report relates to the medical service only. A separate report has been written for the dental service provided by the clinic. You can read the dental report by selecting the ’all reports’ link for Victoria Dental & Healthcare on our website at www.cqc.org.uk.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations. We have told the provider to take action (see full details of this action in the requirement notices and enforcement actions sections at the end of this report).

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check on concerns we had received and whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Victoria Dental & Healthcare (which operates as Victoria Clinic) is registered with the Care Quality Commission (CQC) as an independent provider of dental and medical services and treats both adults and children at one location in Manchester. The clinic is registered with the CQC to provide the following regulated activities:

  • Diagnostic and screening procedures
  • Surgical procedures
  • Treatment of disease, disorder and injury
  • Maternity and midwifery services.

Services are provided primarily to Polish people who live in the United Kingdom with English as a second language and are available on a pre-bookable appointment basis.

This is not a GP service. The clinic employs doctors on a sessional basis who are working within their specialised field of either gynaecology, internal medicine, dermatology, orthopaedics or psychiatry. Medical consultations and diagnostic tests are provided by the clinic. No surgical procedures are carried out.

The nominated individual of the service is also the registered manager. A nominated individual has responsibility for supervising the way in which regulated activities are managed. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The healthcare team consists of:

  • Five dentists (including the registered manager)
  • One dental hygienist
  • Three dental nurses (two of whom are trainees)
  • One head nurse (also a trainee dental nurse)
  • Seven doctors (including an internal medical specialist, gynaecologists, dermatologist, orthopaedist, psychiatrist and aesthetics specialist)
  • A psychotherapist
  • An orthopaedic technician
  • Four non-clinical members of staff including a practice manager and receptionists

All of the doctors and dentists are appropriately registered with either the General Medical Council (GMC) or the General Dental Council (GDC).

Victoria Clinic is open from 11am until 6pm on a Monday and Tuesday; 11am to 10pm on a Wednesday, Friday and Sunday; 11am to 9pm on a Thursday and 9am to 10pm on a Saturday. The provider is not required to offer an out of hour’s service or emergency care. Patients who require emergency medical assistance or out of hours services are requested to contact the NHS 111 service or attend the local accident and emergency department.

Our key findings were:

  • The registered manager had not considered what oversight or governance of clinical practice was required when expanding the service despite being responsible and accountable for quality and safety.
  • Patients’ medical records that we viewed were handwritten and did not always contain sufficient detail. For example some of the records we viewed did not include a diagnosis or record the batch number of injections.
  • Not all doctors had completed safeguarding training to the appropriate level.
  • The system for recording and sharing learning from significant events was not effective. The provider did not have a significant event policy or procedure.
  • The system for communicating and acting on patient safety alerts was not effective.
  • The doctors employed by the service did not attend any team meetings and there was no formal route for sharing relevant information with them. The doctors were not involved in the clinical governance of the practice.
  • Staff were not supported by the provider in their clinical professional development.
  • We did not see any evidence of clinical supervision.
  • Information about services, fees and how to complain was available.
  • Infection control arrangements were good. The premises were clean, tidy and fit for purpose.
  • Medicines and equipment for dealing with medical emergencies were available and an effective system was in place to monitor their use and expiration dates.
  • There was no system in place to ensure that there was appropriate follow up for abnormal blood and other test results.
  • There were limited formal governance arrangements in respect of the medical service offered by the provider.
  • There was a broad range of policies and procedures, but individual documents were not always signed nor dated by the reviewer.
  • The practice was dispensing medicines brought to the UK from Poland which were not licenced for use in the UK. These medicines were not always appropriately labelled when dispensed.

We identified regulations that were not being met and the provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure that patients are protected from abuse and improper treatment.
  • 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.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider should make improvements:

  • Replace the self-inflating oxygen mask and purchase a paediatric oxygen mask.
  • Update the clinic complaints policy to reflect appropriate route of escalation for health care related complaints
  • Review staff awareness of Gillick competency and ensure they are aware of their responsibilities in relation to this.

26 October 2017

During a routine inspection

We carried out this announced inspection on 26 October 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.

This was a joint inspection as part of an independent healthcare service. This report relates to the dental service only. A separate report has been written for the medical service provided by the clinic. You can read the medical report by selecting the 'all reports' link for Victoria Dental & Healthcare on our website at www.cqc.org.uk.

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 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 providing well-led care in accordance with the relevant regulations.

Background

Victoria Dental & Healthcare is located in Manchester city centre and provides private medical and dental treatment to adults and children, predominantly to patients with English as a second language (mainly Polish). They are known locally as Victoria Clinic.

There is lift access for people who use wheelchairs and pushchairs. Car parking spaces, including for patients with disabled badges, are available near the practice.

The dental team includes five dentists, four dental nurses (three of whom are trainees) and a dental hygienist. The clinical team is supported by a practice manager and three receptionists. The practice has three dental 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 Victoria Dental & Healthcare was the principal dentist.

During the inspection we spoke with two dentists, three dental nurses, the dental hygienist, two 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 and Tuesday 11am to 6pm

Wednesday, Friday and Sunday 11am to 10pm

Thursday 11am to 9pm

Saturday 9am to 10pm

Our key findings were:

  • The practice was clean and well maintained.
  • The practice had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • The practice had systems to help them manage risk. Improvements were needed to enable staff to report significant events.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The practice had 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 had 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.

There were areas where the provider could make improvements and 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 the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.
  • Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
  • Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
  • Review the protocols and procedures for use of X-ray equipment giving due regard to guidance notes on the Safe use of X-ray Equipment.

17 October 2013

During a routine inspection

We spoke to five patients who used the service. All of the people we spoke with were happy with the service they had received. Comments included: "I'm petrified of dentists but [the dentist] is great". 'The dentist has done a fabulous job. No complaints'. 'I needed emergency treatment on a Sunday. I'm so glad I found them'. "I work some distance away but will travel back to use them'. And: [The dentist] does some special treatment which means I don't get any pain from injections, it's great".

The practice team consisted of two dentists, a dental technician, dental nurses and reception staff.

We found that patients who used the service were given sufficient information which enabled them to make informed choices about their treatment and costs.

Patient records were clear, personalised and regularly updated with people's health needs. We saw that records were kept secure and patient confidentiality was maintained.

The practice had policies and procedures in place to protect vulnerable people. We saw that staff had been suitably trained and knew who to contact if they suspected abuse.

We found the premises were clean and the practice followed all recommended guidelines from the department of health.

The practice had robust procedures in place for the recruitment of staff and we saw that systems were in place for the practice to deal with and learn from any complaints received.