Archived: Polmedics Limited - Bristol

Updated 18 April 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was carried out on 10 February 2017 of dental services only. Our inspection team was led by a CQC Lead Inspector and included two CQC Inspectors and a Dental Specialist Advisor. The team was also supported by a Polish translator.

During our visit we:

• We conducted a tour of the practice. We were shown the decontamination procedures for dental instruments and the system that supported the patient dental care records.

• Spoke with a dentist, a dental nurse and the practice manager.

• Reviewed the personal care or treatment records of patients.

• We looked at clinical equipment used by this service.

• We reviewed a range of information which included policies and procedures and patient care records.

Updated 18 April 2017

We carried out an unannounced focused inspection on 10 February of Polmedics Limited - Bristol. We carried out this inspection because the provider confirmed to the Commission that this location re-commenced the provision of dental services only to patients as from 7 February 2017 following previous actions taken by the provider to voluntarily suspend all services on 19 December 2016 provided across all Polmedics Ltd locations until 31 January 2017 including Polmedics Limited – Bristol. The provider had taken this course of action following serious concerns raised following a series of inspections carried out at Polmedics Limited - Allison Street, Birmingham on 9 & 30 November 2016, Polmedics Limited - West Bromwich on 16 December 2016 and Polmedics Limited - Rugby on 17 December 2016 identifying serious concerns linked to the provider’s lack of governance and infrastructure arrangements.

This inspection was carried out at the same time as an announced inspection of Polmedics Ltd (the provider) at their administrative head office located at 36 Regent Place, Rugby CV21 2PN to assess their governance, infrastructure and leadership arrangements. During the inspection which had taken place at the administrative head office, we were informed by the provider that Polmedics Limited – Bristol was closed to patients on 10 February 2017. However, we found evidence that this location was open to patients from midday and patient appointments had been pre-booked for the day of our inspection. We therefore commenced our inspection from midday.

Our findings were:

Are services safe?

We found that this practice was not providing safe 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

Polmedics Limited - Bristol is an independent provider of dental and gynaecology services and is located the in Staple Hill area of Bristol, Avon. Services are provided mainly, but not exclusively, to the Polish community who reside in the United Kingdom (UK) and employs mainly Polish clinicians and staff. Services are available to people on a pre-bookable appointment basis. At the time of our inspection, the provider had voluntarily suspended all services with the exception of dentistry as a result of concerns found during previous inspections carried out by the Commission at three other locations during November and December 2016.

The practice holds a list of registered patients and offers services to patients who reside in Bristol and surrounding areas but also to patients who live in other areas of the UK who require their services. The provider provides regulated activities from seven different locations. We were informed by the provider that there are approximately 33,000 registered patients across all Polmedics Ltd locations.

The practice is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures and surgical procedures.

The practice has one dental surgery, a gynaecology room, a kitchen area with a physiotherapy room (separated by a curtain) a waiting area and a reception area. All of the facilities are on the ground floor of the premises along with toilet facilities.

At the time of our inspection, the practice employed four dentists, one trainee dental nurse and a practice manager. A previously employed practice manager is still currently the registered manager. This manager is no longer employed to work at this location and does not have day to day contact with the practice or the provider. The new practice manager had submitted an application to be the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 provider is not required to offer an out of hours service. Patients who need emergency medical assistance out of corporate operating hours are requested to seek assistance from alternative services such as the NHS 111 telephone service or accident and emergency.

Our key findings were:

• The practice had limited formal governance arrangements in place. Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement. For example, there was no evidence of an x-ray audit being completed.
• Arrangements to safeguard children and vulnerable adults from abuse did not reflect relevant legislation and local requirements. The practice manager was unaware who the safeguarding lead was at the practice.
• The practice did not follow guidance about decontamination and infection control issued by the Department of Health, namely 'Health Technical Memorandum 01-05 -Decontamination in primary care dental practices (HTM 01-05)'.

• The provider had not ensured that a registered manager was in place. It is a requirement of registration with the Care Quality Commission where regulated activities are provided to have a registered manager in place. The person that was named as the registered manager was no longer at this practice.

• Risks associated with the carrying on of the regulated activities were not well managed.
• The practice held medicines and life-saving equipment for dealing with medical emergencies in a primary care setting, although there were some gaps with respect to the recommended emergency medicines and equipment.
• The practice had a number of policies and procedures in place to govern activity, but some of these required updating and some policies did not reflect what we found on the day.

We identified regulations that were not being met and the provider must:

• Ensure audits of radiography are undertaken at regular intervals to help improve the quality of service.

• Ensure effective systems and processes are in place for identifying, assessing and monitoring risks and the quality of the service provision.
• Ensure arrangements to safeguard children and vulnerable adults from abuse reflect relevant legislation and local requirements.

• Ensure effective processes for timely reporting, recording, acting on and monitoring of significant events, incidents and near misses are in place.

• Ensure there is effective clinical leadership in place and a system of clinical supervision/mentorship for all clinical staff including trainee dental nurses.

• Ensure that patient safety alerts such as those issued by the Medicines and Healthcare Regulatory Authority (MHRA) are received by the practice, and then actioned if relevant. Put systems in place to ensure all doctors are kept up to date with national guidance and guidelines.
• Ensure that there are appropriate systems in place to properly assess and mitigate against risks including risks associated with infection prevention and control, Hepatitis B and other immunisations, emergency situations, decontamination of dental equipment, and legionella. Review procedures to ensure compliance with the practice annual statement in relation to infection prevention control required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

There were areas where the provider could make improvements and should:

• Ensure a system of appraisals is in place to ensure all members of staff receive an appraisal at least annually.
• Ensure appropriate policies and procedures are implemented, relevant to the practice ensuring all staff are aware of and understand them.