Maxident - Linden Grove

We undertook a focused inspection of Maxident – Linden Grove on 14 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 now meeting legal requirements.

The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a second CQC inspector and a specialist dental adviser.

We undertook a focused inspection of Maxident – Linden Grove on 7 June 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 well led care and was in breach of regulations17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can read our reports of these inspections by selecting the 'all reports' link for Maxident – Linden Grove dental practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 7 June 2019.

Background

Maxident – Linden Green is in Nunhead, in the London borough of Southwark, and provides NHS and 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 two dentists, two trainee dental nurses and one practice manager/ receptionist. The practice has two treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission 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. At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered.

During the inspection we spoke with two dentists, one trainee dental nurse and the practice manager/receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9am to 5.30pm. It is closed for lunch between 1pm and 2pm each day.

Our key findings were:

• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had systems to help them manage risk to patients and staff.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures which reflected current legislation.
• The dentist used dental dam in line with guidance from the British Endodontic Society when providing root canal treatment.
• The practice had implemented a Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) policy and the practice manager/receptionist had undertaken training in this area.
• The staff team were aware of which notifications should be made to CQC.
• The practice had a process for the disposal of amalgam.

We undertook a follow-up focused inspection of Maxident – Linden Grove on 07 June 2019. 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 now meeting legal requirements.

The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

We previously undertook a comprehensive inspection of Maxident – Linden Grove on 27 November 2018 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 or well led care and was in breach of regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Maxident – Linden Grove on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

Our findings were:

Are services safe?

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

The provider had made improvements in relation to the regulatory breach we found during our previous inspection on 27 November 2018.

Are services well-led?

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

The provider had not made sufficient improvements to put right the shortfalls and had not responded to ensure compliance with all the regulatory breaches we found at our inspection on 27 November 2018.

Background

Maxident – Linden Grove is in Nunhead, in the London Borough of Southwark. The practice provides NHS and private treatment for adults and children.

There is level access to the reception area, waiting area and surgery for people who use wheelchairs and those with pushchairs.

The dental team includes a principal dentist, two associate dentists, a qualified dental nurse, and a practice manager who also works as a receptionist. The practice has three treatment rooms, one of which was not in use at the time of this inspection.

The practice is owned by an organisation, 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. At the time of the inspection the practice did not have a registered manager in post.

During the inspection we spoke with the principal dentist and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open from 9am to 5.30pm on Mondays to Fridays.

Our key findings were:

• The provider ensured medicines and equipment used in the management of medical emergencies were available, monitored regularly and in date. Staff were able to operate the oxygen cylinder competently.
• The provider had installed rectangular collimators on radiography machines.
• The provider had assessed the use of sharp instruments.
• The provider had commenced a cycle of radiography audits and a Disability Access audit.
• The provider ensured interpreting services were available, if needed, for patients who could not speak or understand English.
• The provider had ensured that equipment was suitably serviced and checked for safety.
• The provider had not established thorough recruitment procedures.
• The provider had not established suitable processes to manage risks related to fire safety, infection prevention and control, Legionella and the use of dental dam.
• The provider had not implemented effective systems for stock control.
• The provider had not sought evidence of suitable immunity to a vaccine-preventable disease for a member of staff.
• The provider had not ensured that all staff received key training.
• The provider did not demonstrate an understanding of regulations and their responsibilities relating to amalgam use and the Reporting of Injuries, Diseases and Dangerous Occurrences regulations 2013.
• Senior staff were not aware of systems that could be used to report safety incidents externally to the relevant organisations, and they were not aware of notifications they would need to make to the Care Quality Commission.
• There was a lack of an effective process for seeking the views of patients about the quality of the service.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed, and 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:

• Review the practice’s protocols for the use of dental dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the processes and systems in place for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.
• Review staff awareness and understanding of their responsibilities relating to external reporting and notification systems.