Archived: Alma Terrace

We carried out an announced comprehensive inspection at Alma Terrace Dental Surgery on 20 June 2016 and at this time breaches of a legal requirement were found. After the comprehensive inspection the practice wrote to us and told us that they would take action to meet the following legal requirements set out under the Health and Social Care Act (HSCA) 2008: Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, safe care and treatment and Regulation18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, staffing.

On 02 November 2016 we carried out a focused review of this service under section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The review was carried out to check whether the provider had completed the improvements needed and identified during the comprehensive inspection on 20 June 2016. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Alma Terrace on our website at cqc.org.uk

Our findings were:

We found that this practice was providing safe care in accordance with the relevant regulations. Improvements needed had been made.

We found that this practice was providing well-led care in accordance with the relevant regulations. Improvements needed had been made.

Background

The practice offers both NHS and limited private primary care dentistry to both adult patients and children. The practice is open Monday and Thursday from 09.00am to 5.00pm. 09.00am to 12.30pm on Wednesday and Friday. Tuesday is late night opening when the practices opens from 9.00am until 7.00pm

There is one dentist, one qualified dental nurse, and a receptionist. Dental care is offered within the surgery and for their patients within the local care home settings where check-up examinations can be performed.

The principal dentist is the registered provider. A registered provider is registered with the Care Quality Commission to manage the service. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• Staff had received safeguarding training and knew how to recognise signs of abuse and how to report it.
• The practice had access to an automated external defibrillator (AED).
• Staff were up to date with their mandatory training and their Continuing Professional Development (CPD).
• Staff were able to deal confidently with all medical emergencies that may arise and have the right equipment ready for use. Staff training and availability of equipment to manage medical emergencies were in place.

The practice had also acted upon other recommendations:

• Implemented a process for the checking of the emergency oxygen cylinder to ensure it was undertaken on a weekly basis.
• Implemented a process for the recording of water temperatures as stated in the Legionella risk assessment.

We carried out an announced comprehensive inspection on 20 June 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.

The impact of our concerns, in terms of the safety of clinical care, is minor for patients using the service. Once the shortcomings have been put right the likelihood of them occurring in the future is low. We have told the provider to take action (see full details of this action in the Requirement Notices at the end of this report). We will be following up on our concerns to ensure they have been put right by the provider.

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 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 providing well-led care in accordance with the relevant regulations.

Background

The practice offers both NHS and limited private primary care dentistry to both adult patients and children. The practice is open Monday and Thursday from 09.00am to 5.00pm. 09.00am to 12.30pm on Wednesdays and Friday. Tuesday is late night opening when the practices opens from 9.00am until 7.00pm

There is one dentist, one qualified dental nurse, and a receptionist. Dental care is offered within the surgery and for their patients within the local care home settings where check-up examinations can be performed.

The principal dentist is the registered individual. A registered individual 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 46 CQC comment cards providing feedback. The patients who provided feedback were very positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be kind, polite and considerate. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• There was an effective complaints system.
• Staff had not received safeguarding training but knew how to recognise signs of abuse and how to report it.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in place but the infection control audit was not undertaken in line with published guidelines.
• The practice did not have access to an automated external defibrillator (AED)
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current regulations.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• Patients could access routine treatment and urgent care when required.
• The practice was well-led, staff felt involved and supported and worked well as a team.
• The governance systems were effective.

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

• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).

• Ensure that staff are able to deal confidently with all medical emergencies that may arise and have the right equipment ready for use. Staff training and availability of equipment to manage medical emergencies should be in place giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

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

• Review the practice’s process for the checking of the emergency oxygen cylinder to ensure it is undertaken on a weekly basis.
• Review the practice’s process for the recording of water temperatures as stated in the Legionella risk assessment.