Crawcrook Dental Practice

We undertook a focused inspection of Crawcrook Dental Practice on 21 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 remotely by a specialist dental adviser.

We undertook a comprehensive inspection of Crawcrook Dental Practice on 14 May 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 Crawcrook Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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. We then inspect again after a reasonable interval, focusing on the areas 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 breach we found at our inspection on 14 May 2019.

Background

Crawcrook Dental Practice is in Ryton and provides NHS and private treatment to adults and children.

There is level access to the practice and car parking spaces are available near-by.

The dental team includes the principal dentist, six associate dentists, six dental nurses (three of whom are trainees) and four receptionists. In addition, the practice manager and deputy practice manager oversee the day to day running of the practice. The practice has three treatment rooms, one of which is on the ground floor.

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.

During the inspection we spoke with both practice managers and the senior dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday: 9am - 7pm

Tuesday to Thursday: 9am - 5.30pm

Friday: 9am - 4.30pm

Our key findings were:

• The practice had effective leadership.
• Systems to help manage risk to patients and staff had improved.
• Infection prevention and control procedures were in line with national guidance.
• The provider had improved their staff recruitment procedures, in particular for ensuring clinical members of staff were risk assessed if their immunity status to Hepatitis B was unknown.
• Prescription pads were recorded in line with national guidance.
• The provider had acted to improve the security of the clinical waste bin.
• All hazardous substances were risk assessed and stored appropriately.
• Recommendations from the fire risk assessment had been implemented.
• Complaints were responded to, and dealt with, efficiently.
• Staff training was monitored by way of a training matrix.
• The glucagon (medicine used for a diabetic emergency) was stored in the fridge and the temperature was monitored and logged every day.

We carried out this announced inspection on 14 May 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

Crawcrook Dental Practice is in Ryton and provides NHS and private treatment to adults and children.

There is level access to the practice and car parking spaces are available near-by.

The dental team includes the principal dentist, six associate dentists, six dental nurses (three of whom are trainees) and four receptionists. In addition, the practice manager and deputy practice manager oversee the day to day running of the practice. The practice has three treatment rooms, one of which is on the ground floor.

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 12 CQC comment cards filled in by patients. These provided a positive view of the practice.

During the inspection we spoke with both practice managers, four dentists, four dental nurses and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday: 9am - 7pm

Tuesday to Thursday: 9am - 5.30pm

Friday: 9am - 4.30pm

Our key findings were:

• The practice appeared clean and well maintained. One surgery appeared to have dusty drawers (containing dental instruments).
• The provider had infection control procedures which did not reflect 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 risks. The provider should review their systems for assessing and controlling the risks associated with fire, hazardous substances, Hepatitis B and tracking of prescription pads.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The provider should review their practice leadership to ensure it promotes a culture of monitoring for continuous improvement.
• 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 provider could not demonstrate they dealt with complaints efficiently.
• The practice had suitable information governance arrangements.
• The system to monitor staff training was not effective.

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.

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

• Review the storage method of their glucagon medicine, taking into account the guidelines issued by the manufacturer.