Main Street Dental

We undertook a follow up desk-based inspection of Main Street Dental on 23 December 2019. 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 had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of Main Street Dental on 21 August 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 well led care and was in breach of regulation 17 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 Main Street Dental on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 23 December 2019.

Background

Main Street Dental is in Frodsham, Cheshire and provides mainly private treatment to adults and children. The practice also holds a small NHS children’s contract.

There is level access for people who use wheelchairs and those with pushchairs. Fee paying car parking spaces are available near the practice on the main Frodsham road. Free parking can be found on local roads nearby.

The dental team includes a principal dentist and two associate dentists, five dental nurses, four dental hygienists a dedicated receptionist and a practice manager who is also a dental nurse. The practice has four treatment rooms.

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 practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Wednesday 8:30 am to 5:30pm

Thursday 12pm to 7:30pm

Friday 8:30am to 4:30pm

Our key findings were:

• The system in place to ensure low responders to the Hepatitis B vaccination were appropriately risk assessed was effective.
• Systems to ensure the medical emergency kit was checked in line with recognised guidance was embedded.
• Dental hygienists now work with clinical support. Systems are in place to mitigate risks of lone working.
• Legionella prevention was effectively managed.
• The medicines management system was reviewed and reflected published guidance.
• Systems were in place to ensure clinicians remained up-to-date with guidance.
• The practice updated their systems to ensure the dental instrument cleaning process was maintained if the equipment in use failed.
• Patient safety alerts are now received and acted upon effectively.
• The audit process for dental patient care records and infection prevention and control was reviewed and updated.
• Infection prevention and control procedures reflected published guidelines.

We carried out this announced inspection on 21 August 2019 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 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

Main Street Dental is in Frodsham, Cheshire and provides mainly private treatment to adults and children. The practice also holds a small NHS children’s contract.

There is level access for people who use wheelchairs and those with pushchairs. Fee paying car parking spaces are available near the practice on the main Frodsham road. Free parking can be found on local roads nearby.

The dental team includes a principal dentist and two associate dentists, five dental nurses, four dental hygienists a dedicated receptionist and a practice manager who is also a dental nurse. The practice has four treatment rooms.

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.

On the day of inspection, we collected 29 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, 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, Tuesday and Wednesday 8:30 am to 5:30pm

Thursday 12pm to 7:30pm

Friday 8:30am to 4:30pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. We identified that improvements could be made within the decontamination room, these were discussed with the provider for further action to be taken.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Improvement was required to align the checking process to recognised guidance.
• Improvements could be made to help them manage risk to patients and staff more effectively. With the exception of Legionella management systems, these were promptly acted upon.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• 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.
• Staff provided preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Leadership and oversight could be improved.
• Improvements could be made to enhance the practice’s culture of continuous improvement. In particular: Infection prevention and control audits and record keeping audits.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

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

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

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

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance. In particular: Take action to address the damaged material on the dental equipment and review the air flow and sinks in the decontamination room to bring them in line with guidance.