North Street Dental Practice

We carried out this announced inspection on 10 February 2020 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

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

Are services well-led?

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

Background

North Street Dental Practice is in Bourne, a town in the South Kesteven district of Lincolnshire. It provides mostly private dental care and treatment for adults. There is a small contract with NHS England for the provision of NHS dental care for children.

There is level access to the practice for people who use wheelchairs and those with pushchairs through an entrance at the rear of the premises. There are no car parking facilities on site, but there is on street car parking with time restriction at the front of the premises.

The dental team includes two dentists, two dental nurses, one dental hygienist and two receptionists. One of the dentists was on an extended period of leave at the time of our visit but was due to return to work shortly. The practice has three treatment rooms; one on ground floor level.

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.

On the day of inspection, we collected 27 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, one dental nurse, the dental hygienist and two receptionists. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday 9am to 5pm, Tuesday 9.15am to 5pm, Wednesday 9.15am to 2pm, Thursday 8am to 5pm, Friday 9am to 1pm and on six Saturdays during the year, 9am to 1pm.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies, although annual training was overdue. This had been booked. Appropriate medicines and life-saving equipment were available with exception of some clear face masks.
• The provider had systems to help them manage risk to patients and staff. We also noted areas of risk that had not been identified; these required further oversight.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures which mostly reflected current legislation. References or other evidence of previous satisfactory conduct for two staff members were not available for us to view on the day of our visit. A reference for one staff member was forwarded to us afterwards.
• We were not assured that clinical staff always 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 took account of patients’ needs.
• Staff felt involved and supported and worked as a team. They spoke highly of management.
• The provider asked staff and patients for feedback about the services they provided. We noted patient feedback received in CQC comment cards was very positive about staff and care received.
• The provider had systems to deal with complaints.
• Governance arrangements required strengthening.

We identified regulation the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Improve the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Take action to ensure the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Implement an effective system for receiving and responding to patient safety alerts issued by the Medicines and Healthcare products Regulatory Agency.
• Take action to ensure the clinicians take into account the guidance provided by the Faculty of General Dental Practice when completing dental care records and adopting a risk based approach to the frequency of radiographs taken.
• Improve and develop staff awareness of the requirements of the Mental Capacity Act 2005 and Gillick competence. Ensure all staff are aware of their responsibilities under the Act and the principle as it relates to their role.