Guildhall Dental

We undertook a follow up focused inspection of Guildhall Dental on 16 January 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 comprehensive inspection of Guildhall Dental on 11 June 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 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 Guildhall Dental practice on our website www.cqc.org.uk.

As part of this inspection we asked: Remove as appropriate:

• 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 area(s) where improvement was required.

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 breaches we found at our inspection on 11 June 2019.

Background

Guildhall Dental is in Bury St Edmunds, Suffolk and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs on the ground floor, and a lift for access to treatment rooms on the first floor. Staff rooms and offices occupy the second floor. Car parking spaces, including spaces for blue badge holders, are available in car parks near the practice.

The dental team includes eight dentists, one visiting orthodontist and one endodontist, four hygienists, eleven dental nurses and the lead dental nurse, five receptionists, one treatment coordinator and a practice manager. The practice has ten treatment rooms and one patient coordinator room.

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 Guildhall Dental was the practice manager.

During the inspection we spoke with a company compliance coordinator 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 to Friday from 8.30am to 5.30pm.

Our key findings were:

• The provider had systems in place to ensure regular audits of antimicrobials, record keeping, infection prevention and control and radiographs.
• Systems were in place to ensure the practice cone beam computed tomography (CBCT) machine and the eight intra oral X-ray units were all regularly serviced.
• Sharps bins were signed and dated.
• Emergency equipment and medicines were available as described in recognised guidance.
• The provider had systems to help them manage risk to patients and staff. Five-year fixed wire testing had been completed, risk assessments to minimise the risk that could be caused from substances that are hazardous to health were in place and included household cleaning products in use at the practice. A risk assessment was in place for when the dental hygienists worked without chairside support.
• Airflow in the decontamination room had been corrected to ensure it flowed in the right direction. Damage to the decontamination room hatch work surface had been repaired.
• A new legionella risk assessment had been undertaken by an external provider.
• Dental care records were stored securely.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff took care to protect patient’s privacy and personal information.
• The practice team had revisited Mental Capacity Act training to ensure that all staff including non-clinical staff had a better understanding of Gillick competence guidelines.
• Staff had received training and guidance was available on translation services for patients who did not speak or understand English. Access to information in other formats had been revisited to ensure staff were able to direct patients appropriately when required.
• A sedation policy and documents for the assessment of each patient and instruction sheets for sedation escorts were in place. A sedation audit had been completed.
• A risk assessment had been completed for paramedic access, the wheelchair used for assisting patients with limited mobility had been serviced.

We carried out this announced inspection on 11 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

Guildhall Dental is in Bury St Edmunds, Suffolk and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs on the ground floor, and a lift for access to treatment rooms on the first floor. Staff rooms and offices occupy the second floor. Car parking spaces, including spaces for blue badge holders, are available in public car parks near the practice.

The dental team includes nine dentists, one visiting orthodontist and one endodontist, four hygienists, eight dental nurses and the lead dental nurse, five receptionists, one treatment coordinator and a practice manager. The practice has nine treatment rooms and one patient coordinator room.

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 Guildhall Dental was the practice manager.

On the day of inspection, we collected 18 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, the lead dental nurse, four dental nurses, one dental hygienist, one receptionist 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 to Friday from 8.30am to 5.30pm.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. The practice carried out infection prevention and control audits, but not as regularly as recommended by guidance.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect.
• The practice staff dealt with complaints positively and efficiently.

• The provider did not have all emergency medicines or equipment in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.

• Risk assessments to identify potential hazards and the provision of audit to improve the service were limited.

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

Full details of the regulation the provider was not meeting is at the end of this report.

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

• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.