Tooth Booth

We undertook a follow up focused inspection of Tooth Booth on 11 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.

We undertook a comprehensive inspection of Tooth Booth on 14 November 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 well led care and was in breach of regulation 19 (fit and proper persons employed) 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 Tooth Booth on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

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 14 November 2019.

Background

Tooth Booth is in Chichester and provides private treatment to patients of all ages.

There is street level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders are within a short distance.

The dental team includes the principal dentist, one associate dentist, one dental nurse, two trainee dental nurses and three receptionists. The practice has two treatment rooms.

The practice is owned by a partnership 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 Tooth Booth is the principal dentist.

During the inspection we spoke with the principal dentist, a trainee dental nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday to Friday 9am to 5.30pm
• One Saturday a month 9am to 1pm (hygienist service only)

Our key findings were:

• The practice had made improvements to its staff recruitment systems to ensure that information was available regarding each person employed.
• The practice had implemented all recommendations required as part of the fire risk assessment to ensure ongoing fire safety management is effective.

We undertook a follow up inspection of Tooth Booth on 14 November 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 Tooth Booth on 24 April 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, caring, responsive or well led care and was in breach of Regulation 12, Safe care and treatment; Regulation 13, Safeguarding service users from abuse and improper treatment; Regulation 17, Good governance; Regulation 18, Staffing; and Regulation 19, Fit and proper persons employed 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 Tooth Booth on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive?

• 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 24 April 2019.

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 breach we found at our inspection on 24 April 2019.

Are services caring?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 24 April 2019.

Are services responsive?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 24 April 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 fully to the regulatory breaches we found at our inspection on 24 April 2019.

Background

Tooth Booth is in Chichester and provides private treatment to patients of all ages.

There is street level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders are within a short distance.

The dental team includes the principal dentist, one dental nurse, one trainee dental nurse and one receptionist. The practice has two treatment rooms.

The practice is owned by a partnership 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 Tooth Booth is the principal dentist.

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

The practice is open:

• Monday to Friday 9am to 5.30pm

• One Saturday a month 9am to 1pm (hygienist service only)

Our key findings were:

• The practice ensured that care and treatment was provided in a safe way to patients.

• Staff ensured that patients were protected from abuse and improper treatment.

• The practice had improved their systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Staff received appropriate support and training to enable them to carry out the duties they were employed to perform.

• The practice had reviewed the availability of interpreter services for patients who did not speak English as their first language.

• Recruitment procedures did not reflect current legislation.

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

• 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:

• Take action to implement any recommendations in the practice's fire safety risk assessment and ensure ongoing fire safety management is effective.

We carried out this unannounced inspection on 24 April 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 not providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was not 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

Tooth Booth is a dental surgery, in Chichester, West Sussex and provides NHS and private treatment to patients of all ages.

There is street level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders are within a short distance.

The dental team includes the principal dentist, one associate dentist, one dental hygienist, one trainee dental nurse, a practice manager and one receptionist. The practice has two treatment rooms.

The practice is owned by a partnership 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 Tooth Booth is the principal dentist.

During the inspection we spoke with one dentist, one hygienist, the receptionist and the practice manager. Following the inspection, we spoke with the principal dentist and one of the partners for the provider. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday to Saturday from 8am to 6pm

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Areas of the practice were cluttered and required further cleaning. We found a fire exit was blocked with bags of shredded paper and cardboard boxes.
• Infection control procedures did not meet current national guidance.
• Systems to help the practice manage risks to patients and staff were ineffective in that some risk assessments had not been updated since 2017.
• The practice safeguarding processes were ineffective. Some staff lacked awareness of safeguarding vulnerable adults and children, there was no evidence that some staff had received safeguarding training and the practice safeguarding policy had not been updated since 2017.
• The practice recruitment procedures were ineffective. There were no recruitment records for three members of staff, documents such as Disclosure and Barring Services checks, and medical indemnity insurance was not available for all necessary staff.
• There was ineffective clinical and managerial leadership. Improvements were required to ensure that the provider asked patients for feedback about the services they provided.
• The practice had no information governance arrangements in place.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure 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, and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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 practice’s protocols and procedures in relation to the Accessible Information Standard to ensure that that the requirements are complied with.
• Review the availability of an interpreter service for patients who do not speak English as their first language.