Archived: A Primary Dental Practice

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 not providing caring services in accordance with the relevant regulations

Are services responsive?

We found that this practice was not 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

A Primary Dental Practice, also known as Station Road Dental Practice is a dental practice providing mostly NHS dental treatment, with private treatment options for patients. The practice is located on the High Street in Birchington, Kent.

The practice has two treatment rooms, both of which are on the ground floor.

The practice provides dental services to both adults and children. The practice provides mostly NHS treatment (90%). Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment. Dental Implants and cosmetic dentistry are available privately.

The practice’s opening hours are – Monday to Friday 8.40am to 5.30pm

Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message or by telephoning the 111 NHS service.

The principal dentist/owner is registered with the Care Quality Commission (CQC) as an individual. 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 practice has three dentists; one qualified dental nurse and one student nurse.

We did not provide CQC comment cards prior to our visit as this visit was unannounced. We spoke with patients and reviewed feedback that practice had received through the NHS Friends and family test (FFT) and NHS Choices.

Our key findings were:

• The provider did not have emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• Patients said staff were always friendly, polite and professional and they were treated with dignity and respect by staff.
• Patients we spoke with told us that they could usually get an appointment when they needed one and that they had been able to access emergency appointments on the same day.
• Medical oxygen held by the practice was out of date.
• Some staff had not completed training and other staff had lapsed in basic life support and medical emergencies.
• The practice had a system and processes to record, investigate, respond to and learn from significant events. However, no staff when questioned had knowledge of what a significant event was.
• The practice had not carried out effective audits in key areas, such as infection control and the quality of X-rays.
• The practice did not have sufficient safeguarding processes and staff did not understand their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Staff had not completed training for safeguarding vulnerable adults or children.
• The practice did not follow the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning, storing and sterilising dental instruments.
• Operational policies were out of date and contained information that was no longer relevant or followed current guidance and legislation.
• Environmental cleaning was not effective
• The practice did not hold regular staff meetings and formal staff appraisals, and the appraisals undertaken had not identified training needs.
• The practice did not handle complaints effectively or used these to help them improve the practice.
• Clinical governance activity was not sufficient, audits we reviewed did not reflect processes in the practice, and therefore no learning or improvements could be made.

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

• Ensure that staff understand what constitutes a significant event, and establish systems and processes to investigate, respond to and learn from significant events.
• Ensure staff training and availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.
• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum
• 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Ensure infection control audits are undertaken at regular intervals and learning points are documented and shared with all relevant staff.
• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure that a system for identifying, receiving, recording, handling and responding to complaints by patients is established.
• Ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Ensure the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Ensure audits of various aspects of the service, such as radiography are undertaken at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure audit protocols to document learning points are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure that systems and processes are established and operated effectively to safeguard patients from abuse.
• Ensure systems are put in place for the proper and safe management of medicines.
• Ensure that all staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

You can see full details of the regulations not being met at the end of this report. We found this practice was not providing safe care in accordance with the relevant regulations and identified regulations were not being met. We took urgent enforcement action to suspend the practice for one month to allow improvements to be made.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the storage of dental care products to ensure they are stored in line with the manufacturer’s guidance.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
• 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’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review its responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and carry out a Disability Discrimination Act audit for the premises.
• Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by patients.