Ewan Bramley Dental Care

We carried out this announced inspection on 25 June 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 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

Ewan Bramley Dental Care is in North Shields and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes a principal dentist, four associate dentists, two visiting dentists, nine dental nurses (two of whom are trainees), two healthcare assistants, three dental hygienists, a practice manager, a clinic manager and a receptionist. Two of the dental nurses also perform reception duties. The practice has four treatment rooms, with two hygiene bays being in one of the 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 Ewan Bramley Dental Care is the principal dentist.

On the day of inspection, we collected 26 CQC comment cards filled in by patients. These provided a positive view of the practice.

During the inspection we spoke with four dentists, two dental nurses, one dental hygienist, the clinic manager and the practice manager. A compliance-software developer was also present to assist the practice with any software issues. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday - Thursday: 8am to 8pm

Friday: 8am to 3pm

Saturday: 9am to 3pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. A medicine for diabetic emergencies was stored in the fridge and there was no temperature monitoring to ensure temperatures were within the required range.
• The practice had some systems to help them manage risks. The provider should review their systems for assessing and controlling the risks associated with electrical safety, hazardous substances, tracking of prescribed antibiotics and regular servicing of the gas boiler.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. We found seven staff members were not within the recommended interval in safeguarding training.
• The provider’s staff recruitment procedures were not in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• 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 provided preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Management and governance systems were not effective in some areas. Quality assurance and audit processes were not embedded to encourage learning and development.
• 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 dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. 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 the duties.

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 by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.
• Review the practice’s systems to track and monitor the use of prescribed antibiotics.