We carried out this announced inspection on 30 October 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 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 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
Bywood Dental Practiceis based in Bracknell, and provides NHS and private treatment to patients of all ages.
There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces include spaces for patients with a disabled person's blue badge and are available in a public car part at the front of the practice.
The dental team includes the principal dentist, one hygienist, two dental nurses, and two receptionists. The practice has two treatment rooms.
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.
On the day of inspection we collected 34 CQC comment cards filled in by patients and obtained the views of eight other patients.
During the inspection we spoke with the principal dentist, a dental nurse, and a receptionist. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open 9am to 6pm Monday to Thursday and 9am to 5pm on Friday. The practice closes for lunch between 1pm and 2pm every day.
Our key findings were:
- The practice appeared clean and well maintained.
- Not all the practice infection control procedures reflected published guidance.
- Staff knew how to deal with emergencies. Most of the appropriate medicines and life-saving equipment were available.
- The practice had some systems to help them manage risk.
- The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children but records to confirm training had been carried out were unavailable.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The appointment system met patients’ needs.
- Staff felt involved and supported and worked well as a team.
- The practice asked staff and patients for feedback about the services they provided.
- Staff appraisals were not carried out.
- Improvements could be made to review the use of audits, such as those checking the quality of dental care records, to help monitor and improve the quality of service
- There were no records available to confirm that clinical staff completed all the continuous professional development required for their registration with the General Dental Council.
- There were no records available to confirm all clinical staff had Hep B immunity.
- The practice had a procedure in place to deal with complaints.
- Risk assessments had not been carried out for fire and electrical safety.
- There were no records available to confirm that a legionella risk assessment had been undertaken.
We identified regulations the provider was not meeting. They must:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure that accurate, complete and contemporaneous records are maintained securely in respect of each service user.
- Ensure procedures are established to assess, monitor and improve the quality and safety of the services being provided.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
There were areas where the provider could make improvements. They should:
- Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
- Review its responsibilities to meet the needs of disabled people, including those with complex hearing impairments and the requirements of the Equality Act 2010.
- Review availability of an interpreter services for patients who do not speak English as a first language.
- Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.
- Review 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 practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
- Review the current infection control protocols and undertake a Legionella risk assessment and implement the required actions taking into account guidelines issued by the Department of Health - Health Technical Memorandum01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’
- Review its responsibilities as regards the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use and handling of these substances.