Archived: Morden Dentist

We undertook a follow up focused inspection of Morden Dentist on 30 January 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 was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Morden Dentist on 30 July 2018 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 safe or well led care in accordance with the relevant regulations 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 Morden Dentist dental practice on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 30 July 2018.

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made sufficient improvements to put right the shortfalls and had responded to the regulatory breaches we found at our inspection on 30 July 2018.

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/es we found at our inspection on 30 July 2018.

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

The provider had made sufficient improvements to put right the shortfalls and had responded to the regulatory breaches we found at our inspection on 30 July 2018.

Background

Morden Dentist is in the London borough of Merton and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes one dentist (another dentist was due to start in the service in the coming weeks), one dental nurse (who also provides reception duties) and a practice manager. The practice has one 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. The registered manager at Morden Dentist is the principal dentist.

During the inspection we spoke with the principal dentist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Tuesday, Thursday and Fridays from 9.00am to 5.00pm.

Our key findings were:

• The practice had processes in place for safeguarding people from abuse. All staff had received training and the policy had been updated.

• Recruitment checks had been carried out to staff employed at the service and documents were on staff records to reflect this.

• There were systems and processes in place to ensure good governance.

• Information was available at the location, relating to each employed person.

• Staff were aware of their responsibilities in relation to the duty of candour to ensure compliance with the Health and Social Care Act 2008 (Regulated Activities)2014

• The practice responded to the needs of patients with disabilities and there was a Disability Discrimination Act audit for the premises.

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

• Review the practice’s protocols to ensure audits of infection prevention and control and other areas of the service are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

We carried out this unannounced inspection on 30 July 2018 and 8 August 2018 (announced) 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

Morden Dentist is in the London Borough of Merton and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes three dentists, three dental nurses and one trainee dental nurse. The dental nurses also provided reception duties. 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 (CQC) 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. The registered manager at Morden Dentist was the principal dentist.

On the day of inspection we were unable to speak with patients because there were none booked in and the inspection was unannounced.

During the inspection we spoke with one dentist and one of the dental nurses. On the second day of our visit the practice manager from the provider’s other location also attended the inspection and spoke with us. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9.00am to 5.00pm.

Our key findings were:

The practice appeared clean and well maintained.

• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had infection control procedures that were broadly in line with published guidance.
• The practice had staff recruitment procedures; however they were not following their procedures.
• Appropriate medicines and life-saving equipment were available.
• The practice did not have suitable safeguarding processes and not all staff knew their responsibilities for safeguarding adults and children.
• The practice did not have suitable information governance arrangements.
• The practice did not assess and mitigate risks suitably.

We identified regulations the provider was not meeting. They must:

• Ensure suitable processes are in place for safeguarding people from abuse.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

• Ensure specified information is available regarding each person 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. They should:

• Review the practice's protocol and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.
• Review the practice’s systems to monitor and track referrals to ensure that these are dealt with promptly.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.