Park Dental

We undertook a focused inspection of Park Dental on 22 January 2020. 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 meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook an unannounced comprehensive inspection of Park Dental on 9 July 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 safe, effective or well led care and was in breach of regulations 12, Safe Care and Treatment; 19, Fit and proper persons employed and 13, safeguarding service users from abuse of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action against these breaches. This inspection, in February 2020, focused on these breaches of regulation and the actions the provider has taken to address them.

The provider was also in breach of regulations 18, Staffing and 17, good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, where we set requirement notices. We did not follow up on these requirement notices at this inspection in February 2020 as we are ensuring the provider has sufficient time to work through their action plan. You can read our report of that inspection by selecting the 'all reports' link for Park Dental on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

Our findings were:

Are services safe?

We found this practice was still not providing safe care in accordance with the relevant regulations.

The provider had made some improvements but not enough to put right the shortfalls and had not responded to all the regulatory breaches we found at our inspection on 9 July 2019.

Background

Park Dental is in Horfield, Bristol and provides private treatment for adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes one dentist, one dental nurse, one dental hygienist and a receptionist. The practice has two 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 one dentist, one dental nurse, one dental hygienist and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Wednesday 8am-7pm
• Thursday 8am-6:30pm

Our key findings were:

• Systems were in place to ensure staff were aware of how to report safeguarding concerns to the appropriate authorities. Procedures on how to deal with safeguarding were implemented; however, they needed time to embed within the staffing team to ensure staff had adequate awareness and understanding of the process to follow.
• Systems to recruit staff safely required further improvement. This included ensuring staff recruitment systems and procedures reflected current legislation.
• Systems to manage the risks to patients and staff still required improvement. This included the sytems in place to manage fire safety, medicines, immunisation status of staff; and adequate risk assessments for situations in which a dental dam was not used and the hygienist did not have chairside support.
• Systems to manage infection control had improved in some areas and required improvement in others. For example, we found the sterilisers did not have all necessary checks required undertaken to ensure they were safe to use.
• There was not an effective system to ensure actions to reduce the risks associated with legionella were completed.
• Systems to ensure equipment used was maintained according to manufacturer’s guidelines needed improvement.
• Systems to ensure the X-ray equipment was safe to use had improved.

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

• Ensure care and treatment is provided in a safe way to patients.
• 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:

• Ensure the practice’s safeguarding policy was accessible and read and understood by all staff.
• Take action to ensure all clinicians are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Take action to ensure dentists are aware of guidelines issued by the British Endodontic Society for the use of dental dams for root canal treatment; in particular, ensure there are risk assessments in place for when a dental dam for root canal treatment is not used.

We carried out this unannounced inspection on 9 July 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 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 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

Park dental is in Bristol, Horfield and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes one dentist, four dental nurses/receptionists, one dental hygienist. The practice has two 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 spoke with eight patients.

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

The practice is open:

Monday 9am – 5pm

Tuesday, Wednesday & Thursday 9am – 6pm

Friday & Saturday 9am – 1pm

Our key findings were:

• The practice did not appear clean and well maintained.
• The provider did not have infection control procedures which reflected published guidance.
• Staff did not know how to deal with all emergencies. Not all appropriate medicines and life-saving equipment were available.
• The provider had some systems to help them manage risk to patients and staff.
• The provider did not have suitable safeguarding processes and staff were not sure of their responsibilities for safeguarding vulnerable adults and children or how they would contact the relevant authorities.
• The provider did not have 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 some preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider could not prove they have an effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider was unable to evidence they asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had some information governance arrangements.

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

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

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

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

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

• Review the practice's protocols for the completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.
• 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 PHE-CRCE-023 on the safe use of Hand-held Dental X-ray Equipment.