Ponsford 59 Dental Practice

We carried out this unannounced responsive focused inspection on 7 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was carried out due to three sources of concern raised to us particularly in relation to infection control practices, equipment and staffing. The inspection was led by a CQC inspector who was supported by a specialist dental nurse adviser and an assistant inspector.

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. Because this inspection was an unannounced responsive inspection we did not look at all areas. The areas we reviewed were; infection control, radiation, staffing, medical emergencies and equipment.

Our findings were:

Are services safe?

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

Background

Ponsford 59 Dental Practice is in Minehead and provides approximately 90% of NHS services and 10% private treatment to patients of all ages.

There is access for patients who use wheelchairs and pushchairs through the use of a ramp at the front of the practice. There were two car parking spaces. There were no specific spaces for disabled access. There was plenty of on street parking nearby including access to local transport services.

The dental team includes one dentist, who is the nominated individual, two qualified dental nurses, one of which is the practice manager, two dental hygienists and one receptionist. The practice has three 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 is the practice manager and one of the directors of the company. They are also a qualified dental nurse.

During the inspection we spoke with the principal dentist, the dental nurse, the 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 9am to 5:30pm

Our key findings were:

• Staff spoken with felt they were supported and management was approachable to raise concerns with them openly.
• The practice had infection control procedures which needed some improvement to ensure they followed published guidance.
• Staff received training in how to deal with medical emergencies. Appropriate medicines were available. There was life-saving equipment but not all equipment was available that should be available, according to resuscitation council UK guidelines and GDC standards for the dental team.
• There were recruitment procedures in place however these could be further improved to ensure they met with current legislation.

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

• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review the practice system for the sterilising equipment to ensure it is maintained according to manufacturers and infection control guidance and that appropriate maintenance records are held for appropriate intervals according to records management guidelines.
• Review the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate written explanation of any gaps in employment and carrying out a risk assessment if a Disclosure and Barring Service check has not been received prior to employment.
• Review the practice's recruitment policy and procedures to ensure written gaps of employment, how references should be sourced as well as proof of identification are recorded suitably giving due regard to Schedule 3 Information required in respect of persons seeking to carry on, manage or work for the purposes of carrying on, a regulated activity.
• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff particularly in relation to infection control.
• Review the systems in place for prescription pads to monitor and track their use from delivery to use.
• Review stocks of dental materials and the system for identifying and disposing of out-of-date stock.
• Review what should be reported to the Health and Safety Executive and at what intervals, particularly in relation to radiation.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.