We carried out this announced inspection on 20 April 2017 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 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
Days Lane Dental Practice is in Sidcup, Kent, and provides approximately 15% NHS and 85% private treatment to patients of all ages.
There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available on the practice’s premises.
The dental team includes three dentists, three dental nurses (one of whom is currently completing dental nursing training), a dental hygienist, a practice manager, and a receptionist who is a qualified dental nurse and sometimes assists with dental nursing. The practice has three 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.
We received feedback from 22 patients via CQC comment cards and by speaking with patients on the day of the inspection. This information gave us a positive view of the practice.
During the inspection we spoke with two dentists, a dental nurse, a receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open at the following times:
Monday-Thursday 9.00-13.00 and 14.00-17.30, Fridays 9.00-13.30, and on alternate Saturdays by appointment.
Our key findings were:
- Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The practice was clean and well maintained.
- 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.
- The appointment system met patients’ needs.
- The practice asked staff and patients for feedback about the services they provided.
- The practice had not received any complaints in the last 12 months, but they had an effective complaints process in place.
- The majority of staff felt involved and supported and worked well as a team.
- The practice’s infection control procedures did not always reflect published guidance.
- The practice had some systems to help them manage risk, but these were not always managed appropriately.
- The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Improvements could be made to ensure staff had access to safeguarding policies.
- The practice had staff recruitment procedures in place, though improvements could be made to ensure they were followed suitably.
- Leadership and governance arrangements needed to be improved.
- Systems were not in place to assess, monitor and improve the quality of the service.
We identified regulations the provider was not meeting. They must:
- Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
- Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
There were areas where the provider could make improvements and should :
- 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.
- Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
- Review the practice protocol and ensure staff are aware of their responsibilities as per the Duty of candour under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
- Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
After the inspection the provider sent us evidence of actions they were taking to implement the necessary improvements.
Full details of the regulations the provider was not meeting are at the end of this report.