Updated 15 December 2021
We undertook a follow up focused inspection of Dental Surgery Stonegate on 26 February 2020. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.
The inspection was led by a CQC inspector who was supported by a second CQC inspector and a specialist dental adviser.
We undertook a comprehensive inspection of Dental Surgery Stonegate on 17 September 2019 under Section 60 of the Health and Social Care Act 2008 as part of our Regulatory functions. We found the registered provider was not providing effective care and was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Dental Surgery Stonegate on our website www.cqc.org.uk.
As part of this inspection we asked:
- Is it effective?
As part of our regulatory function we found additional areas of concern on the inspection day to ask:
• Is it safe?
• Is it 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?
The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breach we found at our inspection on 17 September 2019.
Are services well-led?
We found this practice was not providing well-led care in accordance with the relevant regulations.
Background
Dental Surgery - Stonegate is in the centre of York and provides mainly private dental treatment to adults and children. The practice also holds a small NHS contract.
Due to the practice being located on the first floor, patients with mobility requirements are referred to a local practice that can help with access more easily.
The dental team includes the principal dentist and two administrators, (one of whom was formerly a dental nurse and one was formerly a trainee dental nurse). Locum dental nurses are employed to provide clinical assistance.
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.
During the inspection we spoke with the principal dentist and one of the administrators. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open: Monday – Friday 9am to 5pm
Our key findings were:
- Some improvement was made to ensure preventative care was provided and support was maintained to ensure better oral health in the longer term.
- The practice’s approach to quality assurance had improved but record keeping remained a concern.
- The provider was now aware of the need to comply with the General Dental Council (GDC) Position Statement on Tooth whitening.
- Systems in place to monitor staff training, in particular, safeguarding vulnerable adults and children and basic life support were not effective.
- The provider did not follow guidance on the use of dental dams from the British Endodontic Society during root canal treatment.
- The use and quality control of dental radiography was not in line Ionising Radiation (Medical Exposure) Regulation and guidance provided by the Faculty of General Dental Practice (FGDP) (UK).
- The completion of dental care records was not in line with nationally agreed guidelines issues by the FGDP and the General Dental Council professional standards.
- Systems in place to ensure locum staff working at the practice were effectively inducted, had the qualifications, competence, skills and experience to care for and treat patients safely were not effective.
- The provider did not ensure that leadership and governance systems were effective.
- Systems to help them manage risk to patients and staff were not fully effective.
- Systems for reviewing and investigating when things went wrong were inadequate.
- We noted the inappropriate use of NHS prescriptions.
- Improvements made to ensure care and treatment provided was in line with current nationally agreed guidelines and regulations were not effective. In particular: The British Society of Periodontology, The Faculty of General Dental Practice (UK) and GDC standards.
- No improvements had been undertaken to address the issue of administrative staff working in areas where there was an infection prevention and control risk.
We identified regulations the provider was not meeting. They must:
- Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Full details of the regulations the provider was not meeting are at the end of this report.