Archived: Bridlington Dental Centre

We carried out an announced comprehensive inspection on 3 November 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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 not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was not providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was not 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

Bridlington Dental Centre is situated in Bridlington town centre, Humberside. The practice offers NHS and a small amount of private dental treatments including preventative advice and general dentistry.

The practice has one surgery, a decontamination room, a waiting area, a reception area and patient toilets. All facilities are located on the first floor of the premises. There are also staff facilities available.

There is one locum dentist, a trainee dental and a receptionist.

The practice is open between the hours of 9am and 5pm Monday – Friday.

The practice owner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 received 14 CQC comment cards providing feedback and we spoke with three patients. The patients who provided feedback were not always positive about the care and attention to treatment they received at the practice. They told us they had no continuity of care and the dentist could be rough. They told us there was poor communication from the practice about the services and patients were waiting for treatment to be completed. Patients also told us the receptionist and dental nurse were excellent, helpful and friendly.

The provider has taken steps to improve following our inspection but further action is necessary.

Our key findings were:

• The practice had poor systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
• Staff had received online safeguarding training, knew how to recognise signs of abuse and how to report it. There was no in house lead for safeguarding.
• There was not sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were not in accordance with the published guidelines.
• Oral health advice and treatment was not provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Treatment was not well planned and provided in line with current best practice guidelines.
• Patients did not receive clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• The appointment system did not met patients’ needs due to the lack of a full time dentist.
• The governance systems were not effective and not embedded.
• There were no defined leadership roles within the practice and staff did not feel supported. The registered manager worked remotely from the practice.

We identified regulations that were not being met and the provider must:

• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.
• 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 recommendations from the current legionella risk assessment are implemented 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.
• Ensure all practice risk assessments are implemented and reviewed including the practice sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Ensure audits of various aspects of the service, such as radiography are undertaken at regular intervals to help improve the quality of service. Practice must also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure that all staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Ensure the storage of records relating to people employed and the management of regulated activities is in accordance with current legislation and guidance.
• Ensure every patient is treated in line with their needs and referred to other services when required.
• Ensure that a system for identifying, receiving, recording, handling and responding to complaints by patients is established.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.
• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• Review the practice protocols and adopt an individual risk based approach to patient recalls giving due regard to National Institute for Health and Care Excellence (NICE) guidelines.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.
• Review the practice confidentiality policy with regard to the use of CCTV cameras within the dental practice and ensure all information, assessments and signage are implemented as per the Information Commissioning Office (ICO) recommendations.
• Review the availability of a practice information leaflet.
• Review the practice’s process for ensuring staff are up to date with their continuous professional development.
• Review the practice's recruitment policy and procedures to ensure immunity to Hepatitis B is requested and recorded suitably.