Archived: Rothwell Dental surgery

We carried out a follow- up inspection at Rothwell Dental surgery on the 2 November 2017.

We had undertaken an unannounced comprehensive inspection of this service 31 July 2017 as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice manager wrote to us to say what they would do to meet the legal requirements in relation to the breaches. This report only covers our findings in relation to that requirement.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rothwell Dental Surgery on our website at www.cqc.org.uk.

We revisited Rothwell Dental Surgery as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We carried out this announced inspection on 2 November 2017 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 questions:

• Is it safe?

• 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 well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Rothwell Dental surgery provides NHS and private treatment to adults and children.

There is level access at the rear of the building for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes two dentists, three trainee dental nurses, three dental hygiene therapists and a practice manager who is also a qualified dental nurse.

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 the dentist, three trainee dental nurses, one dental hygiene therapist 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, Tuesday, Thursday 9am – 5pm

Wednesday 9am – 6pm

Friday 9am – 3pm

Our key findings were:

• The decontamination process now reflected published guidance. We found the zoning had improved. Decontamination of instruments was now effective. The practice had decluttered work surfaces and floors. Clinical waste segregation was embedded.
• The practice had systems to help them manage risk.
• The practice had implemented suitable safeguarding processes for safeguarding adults and children.
• The practice had not implemented staff recruitment procedures.
• The clinical staff were now aware of current guidelines in relation to delivering better oral health.
• Dental care records were now stored securely.
• Governance arrangements were improving to support the smooth running of the practice.
• The practice management and leadership still required improvement.

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

• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.
• Review the practice recruitment policy and procedures to ensure they are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

We carried out this unannounced inspection on 31 July 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. We did not receive any information of concern from them.

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 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

Rothwell Dental surgery provides NHS and private treatment to adults and children.

There is level access at the rear of the building for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes one dentist, two trainee dental nurses, three dental hygiene therapists and a practice manager who is also a qualified dental nurse.

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 the dentist, two trainee dental nurses, one dental hygiene therapist 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, Tuesday, Thursday 9am – 5pm

Wednesday 9am – 6pm

Friday 9am – 3pm

Our key findings were:

Due to the engagement from the registered provider and the practice manager the impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. We have taken appropriate action to safeguard service users whilst the practice continues to demonstrate improvement.

• The decontamination process did not always reflect published guidance. We found the zoning could be improved upon in the surgeries to clarify clean and dirty areas. Decontamination of instruments was not always effective. The practice had cluttered work surfaces and floors. We found improvements could be made to the segregation and disposal of clinical waste in accordance with relevant regulations taking into account guidance.
• The practice had systems to help them manage risk which could be improved upon.
• The practice did not have suitable safeguarding processes and staff did not know their responsibilities for safeguarding adults and children.
• The practice had inconsistent staff recruitment procedures and staff had not received adequate training including safeguarding and CPR.
• Appropriate medicines and life-saving equipment were available.
• The clinical staff were not aware of current guidelines in relation to delivering better oral health.
• The appointment system met patients’ needs.
• Dental care records were not stored securely.
• Governance arrangements were not in place to support the smooth running of the practice. The practice did not have effective management or leadership in place.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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

• Ensure the practice’s infection control procedures and protocols are suitable 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’. Ensure the practice has systems in place for environmental cleaning taking into account current national guidelines.
• Ensure waste handling protocols are in place to ensure it is segregated and disposed of in accordance with relevant regulations taking into account guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Ensure the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Ensure the practice reviews the recruitment policy and procedures to ensure they are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure that the practice reviews all policies’ procedures and training to ensure they are effective. This is in relation to legionella risk assessment and actions, fire risk assessment, mental capacity act, duty of candour and safeguarding vulnerable adults and children.
• Ensure there are training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff. Ensure staff are aware of the requirements of the Mental Capacity Act (MCA) 2005, duty of candour responsibilities and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Ensure dental care records are stored securely.
• Ensure the practice reviews its current audit protocols to ensure audits of key aspects of service delivery are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.

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 security of prescription pads in the practice and ensure there are systems in place to track and monitor their use. Review the storage of glucagon used as part of the medical emergency drugs which should be stored in line with the manufacturer’s guidance and ensure the fridge temperature is monitored and recorded.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review the systems for checking and monitoring electrical safety and gas safety taking into account current national guidance and ensure that all equipment is well maintained.
• Review the practice’s protocols for the use of closed circuit television cameras (CCTV) taking into account guidelines published by the Information Commissioner's Office (ICO).
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping. Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.