Paget Dental Practice

We carried out this announced inspection on 30 April 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 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

Paget Dental Practice is in Wallington in the London borough of Sutton and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the front of the practice for blue badge holders. Parking is also available near the practice.

The dental team includes a practice manager, three dentists, three dental nurses, one trainee dental nurse, one dental hygienist and three receptionists (one of whom was a qualified dental nurse). 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 at Paget Dental Practice is one of principal dentists. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection, we collected eight CQC comment cards filled in by patients.

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

The practice is open: 8.00am to 5.00pm Monday to Fridays. (Thursdays open until 6.30pm) and Saturdays from 9.00am to 1.00pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider asked patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Although this was not always documented suitably in patients’ dental care records.
• Staff were providing preventive care and supporting patients to ensure better oral health. Although this was not always documented in dental care records
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Although improvements were required.
• There was a lack of evidence available on the day of the inspection to demonstrate that the practice completed essential recruitment checks.
• Improvements were required with regards to governance arrangements.
• Improvements were required with regards to having systems in place to manage risk to patients and staff.
• Improvements were required to the staff recruitment procedures.
• The provider did not demonstrate effective leadership nor was there a culture of continuous improvement.

We identified regulations the provider was not complying with. They must:

• Ensure that care and treatment is provided to patients in a way that is safe
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure specified information is available regarding each person employed

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 practice's protocol and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account the guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.