Fern Cottage Dental Practice

We undertook a follow up desk-based inspection of Fern Cottage Dental Practice on 14 October 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 CQC inspector who had remote access to a specialist dental adviser.

We undertook a comprehensive inspection of Fern Cottage Dental Practice on 19 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 regulation 17 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 Fern Cottage Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

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 breach we found at our inspection on 19 June 2019.

Background

Fern Cottage is in Barnsley and provides NHS and private treatment to adults and children.

There is ramp access at the rear of the property for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice on local side roads.

The dental team includes six dentists, five dental nurses (one of whom is a trainee), one receptionist and a practice cleaner. The practice has three treatment rooms.

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.

We reviewed documents that the provider submitted, including written and photographic evidence, to confirm the improvements made since our last visit on the 19 June 2019.

The practice is open: Monday to Friday 9am – 5pm.

Our key findings were:

• The process in place to review the effectiveness of the Hepatitis B vaccination for clinical staff was now effective.
• Fire safety management checks were more effective and were now monitored to ensure compliance. Action was taken to address the ill-fitting front door and uneven pathway into the practice.
• Dental materials which could be considered hazardous to health were now kept in a secured area.
• An improved system was now in place to ensure all relevant patient safety alerts were recorded, retained and acted upon when necessary.
• Improvements had been made to the existing staff induction procedures.
• Staff files and dental care records were now kept securely in line with the General Data Protection Regulations (GDPR).
• Appropriate measures had been taken to repair the damaged dental unit tubing and dental stool.
• Audit systems for infection prevention and control were brought in line with recognised guidance.
• The practice’s complaints procedure and policy was reviewed and updated to reflect changes made.

We carried out this announced inspection on 17 June 2019 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 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 that this practice was 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

Fern Cottage is in Barnsley and provides NHS and private treatment to adults and children.

There is ramp access at the rear of the property for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice on local side roads.

The dental team includes six dentists, five dental nurses (one of whom was a trainee), one receptionist and a practice cleaner. The practice has three treatment rooms.

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 14 CQC comment cards filled in by patients. All comments reflected positively about the service.

During the inspection we spoke with two dentists, three dental nurses and the 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 – 5pm.

Our key findings were:

• The practice appeared clean and well maintained.
• 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.
• Improvements could be made to fire safety systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff recruitment procedures were in place, staff checks and induction processes were not effective.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Leadership and overall governance could be improved.
• The systems to audit standards of infection prevention and control required review.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently. The complaints information available for patients was not up to date.
• Staff files and dental care records were not kept securely in line with the General Data Protection Regulation (GDPR) requirements.

We identified regulations 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 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 infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance. In particular: the use of tape to mend broken tubing and visible damage to dental stools.
• Review the practice’s protocols to ensure audits of infection prevention and control are undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice complaints handling procedures to ensure the most up to date information is available for patients.