Archived: The Smile Centre (UK) Limited

We carried out an announced follow-up inspection at The Smile Centre (UK) Limited on 13 June 2018.

We had undertaken an announced comprehensive inspection of this service on the 27 March 2018 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements. We checked whether they had followed their action plan to confirm that they now met the legal requirements.

We reviewed the practice against two of the five questions we ask about services: are the services safe and well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Smile Centre (UK) Limited on our website at www.cqc.org.uk.

We revisited The Smile Centre (UK) Limited as part of this review and checked whether they now met the legal requirements. We carried out this announced inspection on 13 June 2018 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.

• Is it safe?

• 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 well-led?

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

Background

The Smile Centre (UK) Limited is in the Whitefield area of Manchester and provides private dental treatment to adults.

There is level access for people who use wheelchairs and pushchairs. A ground floor surgery is available but this is only suitable for patients requiring denture work. Car parking spaces are available near the practice.

The dental team includes two dentists, two dental nurses (one of whom is a trainee), a treatment coordinator, a receptionist and a practice manager. The practice has two treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of the inspection the practice did not have a registered manager in post.

During the inspection we spoke with one dentist, two dental nurses, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday from 9:00am to 7:00pm

Friday from 9:00am to 12:30pm

Our key findings were:

• Improvements had been made to the process for reporting significant events.
• Improvements had been made to the process for managing risks associated with fire, Legionella and non-responders to Hepatitis B.
• Improvements had been made to the processes for auditing infection prevention and control minor improvements still needed to be made.
• Some of the issues with the X-ray machine had been addressed. One issue was still outstanding.

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

• Review 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.
• Review the practice’s protocols to ensure audits of infection prevention and control have documented learning points and the resulting improvements can be demonstrated.

We carried out a follow-up inspection at The Smile Centre (UK) Limited on 27 March 2018.

We had undertaken an announced comprehensive inspection of this service on 16 January 2018 as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches. This report only covers our findings in relation to those requirements. We checked whether they had followed their action plan to confirm that they now met the legal requirements.

We reviewed the practice against two of the five questions we ask about services: are the services safe and well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Smile Centre (UK) Limited on our website at www.cqc.org.uk.

We revisited The Smile Centre (UK) Limited as part of this review and checked whether they now met the legal requirements. We carried out this announced inspection on 27 March 2018 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.

• Is it safe?
• Is it well-led?

This question forms the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was not providing safe 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

The Smile Centre (UK) Limited is in the Whitefield area of Manchester and provides private dental treatment to adults.

There is level access for people who use wheelchairs and pushchairs. A ground floor surgery is available. This is only suitable for patients requiring denture work. Car parking spaces are available near the practice.

The dental team includes two dentists, two dental nurses, (one of whom is a trainee), a treatment coordinator and a receptionist. The practice has enrolled the help of a compliance consultant. The practice has two treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of the inspection the practice did not have a registered manager in post.

The organisation had recently undergone a period of change and was now under new ownership.

On the day of inspection, we spoke with one patient. This information gave us a mixed view of the practice.

During the inspection we spoke with one dentist, the dental nurses, the receptionist, the treatment co-ordinator, the compliance consultant and the practice owner. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday from 9:00am to 7:00pm

Friday from 9:00am to 12:30pm

Our key findings were:

• The practice was clean and well maintained.
• Significant events were not consistently reported or recorded.
• Staff had completed training in how to deal with medical emergencies. Appropriate life-saving equipment was available. Not all medical emergency medicines were available.
• The practice had completed a fire and Legionella risk assessment. Recommendations from these risk assessments had not been completed.
• The practice’s recruitment procedures had improved. Further improvements were required to the process for obtaining evidence of immunity to Hepatitis B for clinical staff.
• A patient satisfaction survey had recently been started.
• Complaints were not always dealt with in line with the practice’s policy. Verbal complaints were not always documented.
• Quality assurance processes were not fully embedded within the culture of the practice.
• The practice lacked effective leadership. A new compliance system had been introduced to the practice. Not all staff were familiar with how to access the policies and procedures.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We carried out this announced inspection on 16 January 2018 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 not 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

The Smile Centre (UK) Limited is in the Whitefield area of Manchester and provides private dental treatment to adults.

There is level access for people who use wheelchairs and pushchairs. A ground floor surgery is available but this is only suitable for patients requiring denture work. Car parking spaces are available near the practice.

The dental team includes one dentist, one trainee dental nurse, a treatment coordinator and a receptionist. The practice has recently enrolled the help of a compliance consultant. The practice has two treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of the inspection the practice did not have a registered manager in post.

On the day of inspection we spoke with one patient. This information gave us a positive view of the practice.

During the inspection we spoke with the dentist, the trainee dental nurse, the receptionist, the treatment co-ordinator, the compliance consultant and the company director. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday from 9:00am to 7:00pm

Friday from 9:00am to 12:30pm

Our key findings were:

• The practice was clean and well maintained.
• The staff knew their responsibilities for safeguarding adults and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice dealt with complaints positively and efficiently.
• The practice’s infection control procedures did not always reflect published guidance.
• Staff were unaware of how to use the oxygen cylinder and deliver oxygen to the patient in the event of an emergency. Some emergency medicines had passed their expiry date.
• The practice’s systems to help them manage risk could be improved. For example, recommendations from the Legionella risk assessment had not been actioned and risks associated with non-responders to Hepatitis B had not been assessed.
• The practice’s staff recruitment procedures could be improved. References were not sought for new members of staff and a Disclosure and Barring Service (DBS) check was not available for a staff member.
• Equipment was not maintained according the current guidelines.
• Edentulous patients were not recalled in line with current guidelines.
• The service had recently subscribed to a computer based compliance system. Staff were unaware of how to access policies and had not seen them.
• There had recently been a staffing restructure. There was no clear leader within the service and there were no individual leads.

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

• 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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

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

• Review the practice protocols and adopt an individual risk based approach to patient recalls taking into account National Institute for Health and Care Excellence (NICE) guidelines.