Preston House Dental Practice

We carried out this announced comprehensive inspection on 11 July 2023 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 and maintained.
• The practice had infection control procedures which did not reflect published guidance.
• Some staff knew how to deal with medical emergencies, although not all staff had completed training. Not all the minimum appropriate medicines and life-saving equipment were available.
• The practice did not have efficient systems to manage risks for patients, staff, equipment, and the premises.
• Safeguarding processes were in place, this could be improved. Staff knew their responsibilities for safeguarding vulnerable adults and children. However, not all staff had completed training to the correct level. The safeguarding policies did not contain up to date information.
• The practice had staff recruitment procedures which did not wholly reflect current legislation.
• Clinical staff provided patients' care and treatment in line with current guidelines.
• 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.
• Some of the staff did not always feel involved and supported. We saw they worked as a team.
• Staff and patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• The practice did not have information governance arrangements.

Background

Preston House Dental Practice is in Sandwich, Kent and provides private dental care and treatment for adults and children.

There are steps leading into the practice, people who use wheelchairs and those with pushchairs would have difficulty entering the building. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice had not made or considered reasonable adjustments to support patients with access requirements.

The dental team includes 2 dentists, a qualified dental nurse, a trainee dental nurse, a dental hygienist, a practice manager and 2 receptionists. The practice has 3 treatment rooms. One of the treatment rooms is not currently in use.

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

The practice is open:

• Monday to Thursday 8.30am to 4.30pm
• The practice is closed for lunch between 12.30pm and 1.30pm

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

• Ensure care and treatment is provided in a safe way for service users.
• 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.
• Improve 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'.
• Improve the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained. (In particular, servicing of the equipment in a timely manner and in line with the manufactures, and current legislation for the servicing and maintenance of equipment.
• Improve the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.
• Improve the practice's arrangements for ensuring good governance and leadership are sustained in the longer term.
• Improve the practice's recruitment policy and procedures to ensure accurate, complete, and detailed records are maintained for all staff.
• Take action to ensure that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Develop systems to ensure an effective process is established for the on-going assessment, supervision, and appraisal of all staff. Including the training, learning and development needs of individual staff members at appropriate intervals.

• The proper and safe management of medicines could be improved. In particular: We saw all the required information was not documented on medicines dispensed by the practice, such as the practice name and address.

Full details of the regulation/s the provider is not meeting are at the end of this report.

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

• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Implement an effective system of checks of medical emergency equipment and medicines taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.