Dental Surgery

We carried out this announced inspection on 9 May 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 Care Quality Commission (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 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 not 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

Dental Surgery is in Erith, within in the Greater London Borough of Bexley. The practice providers NHS and private treatment to adults and children.

The practice is open from 9am to 5pm Monday to Friday and is closed from 1pm to 2pm for lunch.

The practice has one treatment room.

There is no level step-free access for people who use wheelchairs or those with pushchairs. Car parking spaces, including those for blue badge holders, are available on the roads near the practice.

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.

The dental team includes two dentists, two qualified dental nurses, three trainee dental nurses, and a receptionist. All of the dental nurses also undertake receptionist duties.

During the inspection we spoke with the principal dentist, one of the qualified dental nurses, and the receptionist. We checked practice policies and procedures and other records about how the service is managed.

On the day of the inspection we collected feedback from seven CQC comment cards filled in by patients.

Our key findings were:

• The practice appeared clean.
• The appointment system took account of patients’ needs.
• The provider had procedures to help them deal with complaints.
• Staff felt supported.
• The provider had not established thorough staff recruitment procedures.
• The provider’s infection control procedures did not reflect published guidance in some areas.
• The provider had not established processes to ensure medical emergency equipment was available and date .
• Some equipment had not been suitably maintained.
• The practice had not established effective systems to help them manage risk to patients and staff.
• The provider did not have suitable safeguarding guidance.
• The clinical staff did not record patients’ care and treatment in line with current guidelines.
• The clinical staff did not use dental dam when carrying out root canal treatments.
• The provider had not implemented an effective system for managing and tracking outgoing referrals.

We identified regulations the provider was not complying with. They 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 persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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. They should:

• Review the practice’s systems in place for environmental cleaning, taking into account current national guidelines.
• Review the practice’s protocols for the use of dental dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.