Mrs E Dimitrijevic - Dental Surgery

We carried out this comprehensive inspection on 11 January 2024 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 clean but surfaces in clinical areas were cluttered in a way that prevented thorough cleaning.
• The practice had some infection control procedures which reflected published guidance. We found these were not applied consistently.
• Staff did not know how to deal with medical emergencies. Appropriate medicines and life-saving equipment were not always available.
• The practice’s systems to manage risks for patients, staff, equipment and the premises were ineffective. We identified shortfalls in assessing and mitigating risks in relation to fire safety, legionella management, prescription security and medicine management, radiography, the safe handling and disposal of sharps and domestic cleaning.
• Safeguarding processes were not in place, staff knew their responsibilities for safeguarding vulnerable adults and children, but contact information and guidance was not available.
• Staff recruitment procedures did not reflect current legislation.
• Clinical staff provided patients’ care and treatment in line with current guidelines. However, this was not always recorded in the patient’s clinical record.
• Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system worked efficiently to respond to patients’ needs.
• The frequency of appointments was agreed between the dentist and the patient, giving due regard to National Institute of Health and Care Excellence (NICE) guidelines.
• The provider did not demonstrate effective leadership or support a culture of continuous improvement.
• Staff felt involved, supported and worked as a team.
• Staff and patients were asked for feedback about the services provided.
• The practice information governance arrangements were ineffective.

Background

Mrs E Dimitrijevic - Dental Surgery is in Thundersley, Benfleet, Essex and provides private dental care and treatment for adults and children.

There is step free access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made reasonable adjustments to support patients with access requirements.

The dental team includes 1 dentist and 1 dental nurse. The practice has 1 treatment room.

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

The practice is open:

Monday and Tuesday from 2pm to 8am.

Wednesday closed.

Thursday and Friday 9am to 3pm (closed from 12pm to 1pm).

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure all premises and equipment used by the service provider is fit for use.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider is not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment. In particular, ensure local rules are updated and in line with current guidelines, and ensure a rectangular collimator is available.
• Improve the practice protocols regarding auditing patient dental care records to check that necessary information is recorded.