Dental Surgery

We carried out this announced comprehensive inspection on 9 June 2023 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 practice was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations.

The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:

• The dental clinic appeared generally clean, however we found that the work surfaces and drawers in the treatment room were cluttered and not able to be cleaned easily.
• The practice infection control procedures did not reflect published guidance.
• Staff did not know how to deal with medical emergencies. Appropriate medicines and life-saving equipment were not available.
• The practice did not have systems to manage risks for patients, staff, equipment and the premises.
• Safeguarding processes were not in place and staff did not know their responsibilities for safeguarding vulnerable adults and children.
• The practice did not have suitable recruitment procedures to comply with current legislation.
• Care and treatment provided to patients were broadly in line with current guidelines. Improvements were needed to ensure details of care provided to patients was suitably recorded within the dental care records.
• Patients were treated with dignity and respect. Improvements were needed to ensure patients` personal information was stored securely.
• Improvements were needed to ensure that preventative care advice given to patients was suitably recorded within the dental care records.
• The appointment system worked efficiently to respond to patients’ needs.
• There was ineffective leadership and a lack of oversight of the day-to-day management of the service.
• There were ineffective systems to support continuous improvement.
• Patients were not asked for feedback about the services provided.
• The practice had a complaints procedure in place.
• The practice did not have effective information governance arrangements.

Background

Dental Surgery is in Colindale, in the London Borough of Barnet and provides NHS and private dental care and treatment for adults and children.

The practice is on the first floor of a high street building and is not accessible to people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The practice has 1 treatment room. The dental team includes the principal dentist and 1 other member of staff, who provides chairside assistance, and also undertakes receptionist duties.

During the inspection we spoke with the dentist and the support staff member. We looked at practice policies, procedures and other records to assess how the service is managed.

The practice is open:

Monday, Tuesday, Wednesday and Friday from 9am to 5pm.

Thursday from 9am to 12pm.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
• Ensure persons employed in the provision of the regulated activities receive appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are 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:

• Take action to ensure dentists are aware of the guidelines issued by the British Endodontic Society for the use of rubber dam for root canal treatment.
• Take action to ensure audits of record keeping and antimicrobial prescribing are undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.