Archived: Malherbedentalclinics Ltd Also known as Groundwell Dental Practice

We carried out an announced comprehensive inspection on 2 November 2015 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 this practice was providing safe care in accordance with the relevant regulations

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations

Background

Malherbedentalclinics Ltd is a dental practice providing private treatment and caters for both adults and children. The practice is situated in a converted residential property. The practice had two dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments and a reception and waiting area. These facilities were all on the ground floor enabling disabled access.

The practice has one dentist a part time dental hygienist and a qualified dental nurse. Supporting the dentist was a practice manager and a receptionist. The practice’s opening hours are 9am – 5pm Monday to Friday.

The provider 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.

We carried out an announced comprehensive inspection on 2 November 2015 to follow up on the breaches of regulation found at the last inspection on 1 September 2015. Following the last inspection we asked the provider to take action through Requirement and Warning Notices for the following regulations; 10 Dignity and respect; 12 Safe care and treatment; 15 Premises and equipment; 17 Good governance; 19 Fit and proper persons employed.

At this inspection we found the provider had taken action and had addressed all the areas of concern identified in the last report. We found the provider was providing the regulated activities in accordance with the relevant regulations.

Our key findings were:

• The patients we spoke with indicated patients were consistently treated with kindness and respect by staff. It was reported communication with patients and their families, access to the service and to the dentist, was good. Patients reported good access to emergency appointments which were available the same day.

• The practice was meeting the Essential Quality Requirements under HTM 01-05 (national guidance for infection prevention control in dental practices’).

• A new staff team had been employed and all demonstrated knowledge and understanding of their role and appropriate competencies to perform it.
• There was now a portable suction unit for use in the management of common medical emergencies in dental practice.
• Dental X-rays were routinely assessed for the quality of image, justified and reported upon in accordance with IR(ME)R 2000 regulations.
• There was evidence of recent clinical audit being undertaken at the dental practice.
• Appropriate recruitment processes and checks were undertaken in line with safer recruitment guidance for the protection of patients.

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

• Ensure infection control audits are completed every six months in accordance with national guidance.
• Ensure the “coning off” issues identified in the inspection are addressed as discussed.

We carried out an unannounced comprehensive inspection on 1 September 2015 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 this practice was not providing safe care in accordance with the relevant regulations

Are services effective?

We found this practice was not providing effective care in accordance with the relevant regulations

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations

Background

Malherbedentalclinics Ltd is a dental practice providing private treatment and caters for both adults and children. The practice is situated in a converted residential property. The practice had two dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments and a reception and waiting area. These facilities were all on the ground floor enabling disabled access.

The practice has one dentist and two dental nurses both of whom are in training. Supporting the dentist was a full time practice manager. The practice’s opening hours are 9am – 5pm Monday to Friday.

The provider 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.

We carried out an unannounced comprehensive inspection on 1 September 2015 to follow up on the breaches of regulation found at the last inspection on 17 August 2015. Following the last inspection we asked the provider to take action through requirement notices for the following regulations; 9 Person centred care; 11 Need for consent; 12 Safe care and treatment; 13 safeguarding service users from abuse and improper treatment; 15 Premises and equipment; 17 Good governance; 19 Fit and proper persons employed; and asked the provider to submit an action plan to us within 24 hours of the inspection. This inspection took place over one day and was carried out by a lead inspector and a specialist dental specialist adviser. Following this inspection we have taken action following our enforcement policy and the provider has been served warning notices following the lack of improvement found.

Our key findings were:

• The patients we spoke with indicated patients were consistently treated with kindness and respect by staff. It was reported communication with patients and their families, access to the service and to the dentist, was good. Patients reported good access to emergency appointments which were available the same day.

• The practice was not meeting the Essential Quality Requirements under HTM 01 05 (national guidance for infection prevention control in dental practices’).

• Staff had undergone recent training in infection prevention control but it was insufficient and staff’s knowledge had not been checked or assessed to ensure they had understood the training and were able to apply it in practice for the safety of patients.

• Staff had undergone recent training in dealing with common medical emergencies in the dental practice and demonstrated good knowledge and understanding of how to manage such an incident if one should occur.
• Dental nurses working in the practice did not fully understand the basic mechanism of operation of the practice autoclave (a machine used in the sterilisation of dental instruments) or the ultrasonic washer (a machine used to clean dental instruments).

• There was no portable suction unit for use in the management of common medical emergencies in dental practice.
• Dental X-rays were not routinely assessed for the quality of image, or justified and reported on in accordance with IR(ME)R 2000 regulations.
• There was no evidence of any recent clinical audit being undertaken at the dental practice.
• Appropriate recruitment processes and checks were not undertaken in line with safer recruitment guidance for the protection of patients.

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

• Ensure the practice fully meets the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM01-05)' as soon as practically possible.

• Provide appropriate suction equipment for use in the management of dental emergencies

• Provide training and competency assessment for staff about infection prevention and control and ensure all process adheres to the national guidance HTM 01-05.

• Develop clear leadership, management and governance of the practice to ensure the delivery of safe care and treatment, supported by learning promoting an open culture.

• Ensure staff are aware of policies and procedures implemented to meet health and safety regulations, for example the reporting of incidents and accidents.

• Ensure dental X-rays when taken are justified, reported upon and quality assessed on each occasion.

• Provide a written plan and implementation schedule (of when and by whom with time frames) of clinical audit as soon as practically possible for infection control, dental X-rays, clinical record keeping and other such audits as expected by the General Dental Council standards.

• Provide clear leadership, management and governance of the practice and assess service delivery to assure the delivery of quality, patient centred treatment and care, supported by learning and innovation, and promote an open and fair culture.

• Ensure records of identification checks are included in staff personnel files and all details as required by legislation are provided. Ensure written risk assessments are in place to assess the need for criminal record checks for non-clinical staff or those for whom no completed DBS check has been received.

• Ensure treatment room doors are shut when treating patients to maintain dignity and confidentiality.

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

• Ensure clinical records capture more detail about the patient assessments, treatment options and associated risk and benefits of proposed treatment in accordance with the current guidance in relation to the frequency of carrying out basic periodontal examination scoring.