We carried out an announced comprehensive inspection on 4 May 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?
Our findings were:
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 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
Newnham Dental Practice provides private dental treatment to patients of all ages. The principal dentist employs two dental nurses, two receptionists and two hygienists also provides services to the practice.
The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.
We received feedback from 30 patients during the inspection process. All of the patients provided positive comments about the quality of care they received, cleanliness of the premises and told us that staff were respectful, professional and understanding.
Our key findings were:
- Staff were committed to providing a positive patient experience, were hard working and caring.
- The practice did not have robust systems in place to help ensure patient safety. These included responding to medical emergencies, managing infection control risks and the appropriate management of environmental risks.
- The practice did not meet the standards required to ensure compliance with Health Technical Memorandum 07-01 (HTM 07-01) and Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
- Staff completed continuing professional development to maintain their professional registration. However, there was no process in place to identify core training and monitor whether this had been completed.
- Patients’ care and treatment was mostly planned and delivered in line with evidence based guidelines, best practice and current legislation.
- Patients reported that they were well treated by staff and received sufficient information about their care and treatment.
- Appointments were easy to access and this included emergency appointments that were available each day for patients who required urgent treatment.
- The practice did not have robust quality monitoring systems and did not have a regular audit plan in place to ensure the quality and safety of key service areas, including infection control.
We identified regulations that were not being met and the provider must:
- Ensure the 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 that infection control procedures are suitable and followed by staff. Undertake a Legionella risk assessment and implements the required actions. These actions must be in line with 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 the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
- Ensure that the storage and disposal of waste is in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
- Ensure the practice has a recruitment policy that is in line with Regulation 19 and 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 an effective system is established to assess, monitor and improve the quality of the service and to mitigate the various risks arising from undertaking of the regulated activities.
- Ensure systems are put in place for the proper and safe management of medicines.
You can see full details of the regulations not being met at the end of this report.
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 practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurances and, ensuring that imporvements are made as a result
- Review the practice’s safeguarding policy and staff training ensuring it covers both children and adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
- Review the training, learning and development needs of staff members including awareness of safeguarding procedures and of the Mental Capacity Act 2005. Introduce a system to monitor and review progress with training at appropriate intervals and an effective process for the on-going assessment and appraisal of all staff employed.
- Review staff awareness of safeguarding procedures and of the Mental Capacity Act 2005 so that staff are aware of their responsibilities in relation to their role.
- 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.
- Review the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure they are stored securely. Review all relevant documentation to ensure it is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
- Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
- 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 ensuring this includes the formal recording of risks and benefits of proposed treatment options. This should give due regard for guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
- Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development.
- Introduce a system to monitor patient referrals and routinely offer patients a copy of their referral letters.
- Review the complaints policy and information available so that it is consistent. Introduce a process for recording the actions taken and the resulting outcomes following the investigation of complaints.