Archived: Whiteladies Dental Care

Updated 18 February 2016

We carried out an announced, comprehensive inspection on 22nd October 2015. The inspection took place over one day.

The inspection was led by a CQC inspector. They were accompanied by a dentist specialist advisor.

We reviewed information received from the provider prior to the inspection. We also informed the local Healthwatch and NHS England that we were inspecting the practice; NHS England raised some concerns about the dentist’s training and continual professional development.

During our inspection visit, we reviewed policy documents and dental care records. We spoke with three members of staff and the dentist. We conducted a tour of the practice and looked at the storage arrangements for emergency medicines and equipment. We observed a dental nurse and the hygienist carrying out decontamination procedures of dental instruments and also observed staff interacting with patients in the waiting area.

21 people provided feedback about the service. Patients we spoke with, and those who completed comment cards, were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 18 February 2016

We carried out an announced comprehensive inspection on 22nd October 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 that this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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

Whiteladies Dental Care is located in the Clifton area of Bristol and provides mainly NHS and some private treatment. The practice consists of three treatment rooms, although one is not currently in use, and a decontamination room. The premises also has toilet facilities (separate for patients and staff), a reception/ waiting area and a staff room.

The practice treats both adults and children. At present the practice operates only one dental surgery and one hygienist surgery. The practice has recently been refurbished and has moved from another part of the building. There is a reception area with the facility to provide information by video. The practice offers routine examinations and treatment. It is run by one dentist who is also the registered provider.

The practice’s opening hours are

8am – 4pm on Mondays, Thursdays and Fridays,

10am – 6pm on Wednesdays and Thursdays.

We carried out an announced, comprehensive inspection on 22nd October 2015. The inspection took place over one day. The inspection was led by a CQC inspector. They were accompanied by a dentist specialist advisor.

Before the inspection we looked at the NHS Choices website. In the previous year there had been four negative reviews with comments including, “appalling treatment,” “dreadful” and “worst dentist I have ever visited.” The dentist had not made any response to this negative feedback.

For this inspection 21 people provided feedback to us about the service. Patients we spoke with, and those who completed comment cards, were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff. Patients told us that the dentist listened to what they said, explained things clearly, involved them in planning their treatment and obtained their consent. They said that the dentist took a medical history and updated it at each visit. They told us that the practice was clean and hygienic. We received no negative comments.

Our key findings were:

• Some safe systems and processes were in place, including a lead for safeguarding and infection control. However, staff were not following guidance about the decontamination of instruments.

• Staff recruitment policies were appropriate and most relevant checks were completed although we saw no evidence that refernces were being taken up. New staff had been provided with an induction into the practice.

• The practice had ensured that risk assessments were in place and that they were regularly reviewed.

• The clinical equipment in the practice was appropriately maintained. The practice appeared

visibly clean throughout.

• The practice maintained appropriate dental care records and patients’ clinical details were updated suitably.

• Patients were provided with health promotion advice to promote good oral care.

• All feedback that we received from patients was positive; they reported that it was a caring and

effective service.

• There were appropriate governance systems in place at the practice including a system of audit.

We identified regulations that were not being met and the provider must:

• Make sure that the process for cleaning and decontamination of instruments follows the relevant guidance, HTM01-05

• Ensure that dental care products requiring refrigeration are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

You can see full details of the regulations not being met at the end of this report.

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

• Make sure all recruitment checks for staff are kept together so that they are available for inspection.

• Follow guidance about hand washing and infection control, including ‘bare below the elbows,’ when selecting work clothing.

• The washer disinfector should be used to add an additional level of cleaning before sterilising of instruments.

• A Legionella risk assessment should be carried out by an independent specialist firm.

• The blood glucose measuring device should be stored with the emergency drugs so that it is readily available in the event of a medical emergency.

• Glucogen injections should be stored in the fridge or if stored out of the fridge the time out of the fridge should be monitored so that it does not exceed eighteen months or exceed the use by date.

• The nurses should receive accredited training about radiography.

• All staff should receive accredited training about health and safety and equality and diversity.

• The dentist should update their training to meet the requirements of NHS England including training about record keeping, claims probity, correct prescription of radiographs, treatment planning, extra-coronal restorations, cast restorations, and planning and carrying out root canal treatments.