A & D Dental Practice Ltd

We carried out a focused inspection of A & D Dental Practice on 27 November 2017.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

The Care Quality Commission received information of concern relating to a failure to assess patients’ ability to consent to treatment. These issues had arisen in the domiciliary dental care service operated by the provider. This focussed inspection only addressed the domiciliary dental care arrangements at the practice.

Our findings were:

Are services effective?

We found this practice was not providing effective care in accordance with the relevant regulations.

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

• Ensure that care and treatment of patients is only provided with the consent of the relevant person

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

We carried out this announced inspection on 24 August 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not have any relevant information to share with us regarding this dental practice.

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

A & D Dental Practice is located close to Nottingham city centre and provides private dental treatment to patients of all ages. The practice also undertakes domiciliary visits to patients in their own homes.

Patient areas of the practice are located on the ground floor with level access from the front door. The practice has one treatment room. There is a pay and display car park close to the premises.

The dental team includes one dentist; one qualified dental nurse; one receptionist; and one accounts administrator.

The practice is owned by an organisation 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. The registered manager at A & D Dental practice is the dentist.

On the day of inspection we collected 15 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, one dental nurse, one receptionist and the accounts administrator. We looked at practice policies and procedures and other records about how the service is managed.

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

Our key findings were:

• Most areas of the practice were clean and well maintained.
• The practice asked staff and patients for feedback about the services they provided and received positive feedback.
• The practice had infection control procedures which did not follow published guidance.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available.
• The practice had suitable safeguarding processes. Staff had been trained and knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took measures to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice dealt with complaints positively and efficiently.

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 audits of key aspects of service delivery are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.

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 protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray equipment.
• Review the practice’s systems in place for environmental cleaning taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review the systems for checking and monitoring electrical equipment taking into account current national guidance and ensure that all equipment is well maintained.

• 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 protocols and procedures for domiciliary visits taking into account current guidance.