Archived: Atherstone Dental Practice Partnership

We carried out this unannounced inspection on 4 March 2020 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

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

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

Atherstone Dental Practice Partnership is in Atherstone, Warwickshire and provides NHS and private dental care and treatment for adults and children.

The practice is situated above a commercial business and is accessed through a streetside entrance leading immediately to a flight of stairs to the first floor. The practice informs all new patients wishing to register that they are not wheelchair accessible and they signpost patients that cannot manage the stairs to a nearby practice. Car parking including spaces for blue badge holders are available in local free of charge car parks within a five-minute walk from the practice.

The dental team includes four dentists, one qualified dental nurse, five trainee dental nurses and two receptionists. The team are supported by two practice managers and a head nurse that works across several practices within the group. The practice has three treatment rooms.

The practice is owned by a partnership and as a condition of registration must have a person registered with the 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 Atherstone Dental Practice Partnership is one of the practice managers.

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

During the inspection we spoke with two dentists, three dental nurses (one of whom is the group head dental nurse and one is a trainee dental nurse), one receptionist and two practice managers. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday, Wednesday and Fridays from 8.30am to 5.30pm.

Thursdays from 8.30am to 7.30pm.

Saturdays from 9am to 2pm.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained. However, we found that there was a leak from the dental unit in one of the treatment rooms. We saw that an engineer had attended the day before, but the fault had reoccurred. This was reported to the engineer during our inspection.
• The provider had infection control procedures which mostly reflected published guidance. There were two illuminated magnifiers and both lights were not working, this had not been reported to management by staff. New magnifiers were ordered during our inspection. Sharp bins were not all labelled and disposed of in accordance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. These shortfalls were rectified during the inspection.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. However, we found that the defibrillator pads had exceeded their October 2019 expiry date. Replacement pads were ordered during the inspection.
• The provider had some systems to help them manage risk to patients and staff. No incidents, near misses or significant events had been recorded although we found incidents had occurred. We found shortfalls in appropriately assessing and mitigating risks in relation to infection control processes, medical emergency equipment, staff recruitment, incident reporting and fire. Immediate action was taken within 48 hours of our inspection to address most of these shortfalls.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures which mostly reflected current legislation. There had been a large turnover of staff in the past 12 months and there were suitable numbers of staff employed. However, we were not shown disclosure and barring service checks for six staff members, these were applied for during the inspection.
• 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 supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had a management team to provide leadership to the practice staff which consisted of two practice managers, both of whom were qualified dental nurses, and a head dental nurse. The team supported several practices within the group.
• The provider had a culture of continuous improvement. Online training was funded and provided for all trainee dental nurses alongside some in house training.
• Staff told us they felt involved and supported and worked as a team. They told us they enjoyed working at this practice.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had 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 regulations the provider was not meeting are at the end of this report.