Smile Dental Care Accrington

We carried out this focussed announced inspection on 28 September 2021 with a second unannounced inspection visit on 7 October 2021 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 questions:

• Is it safe?

• Is it effective?

• 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 not 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 well-led?

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

Background

Smile Dental Care Accrington is based in Accrington, Lancashire and provides NHS and private dental care and treatment for adults and children.

The practice is not accessible to those with limited mobility. Car parking spaces, including dedicated parking for people with disabilities, are available near the practice in pay and display care parks.

The dental team includes two dentists, four dental nurses, two of whom are trainee dental nurses and one who also works as the practice manager. There is also a dental hygiene therapist and a receptionist. The practice has two treatment rooms, both of which are accessed via a staircase to the first floor.

The practice is owned by a company 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. The registered manager at Smile Dental Care Accrington is an area manager, who oversees practices in the corporate group.

During the inspection on 28 September 2021 we spoke with a dental nurse, a receptionist, the practice manager, the registered manager and the clinical lead for the corporate group the practice is part of. Only the receptionist was based at Smile Dental Care, Accrington. We looked at practice policies and procedures and other records about how the service is managed.

On 7 October 2021 we spoke with a dental hygiene therapist, a trainee dental nurse and a receptionist who were all part of the established staff team. We also spoke with the practice manager from a sister practice who had come to assist with this inspection.

The practice is open: Monday to Friday 9am to 5pm and closed each day from 1pm to 2pm for lunch.

Our key findings were:

• The provider had infection control procedures in place. We observed gaps in these, where processes did not reflect published guidance.
• Further attention to cleaning of dental surgeries was required.
• Aspects of the practice and equipment required maintenance.
• 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, however knowledge and management of these required strengthening.
• 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 clinical staff 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.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The leadership of the practice required further support and development. Evidence of continuous improvement was limited.
• The provider dealt with complaints positively and efficiently; we observed the complaints policy in place did not reflect NHS guidance for handling and responding to complaints.
• The provider had information governance arrangements.

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

• Ensure care and treatment is provided in a safe way to patients

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

Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

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:

• Improve the practice's protocols for medicines management and ensure all medicines are stored and dispensed of safely and securely. In particular the storage of local anaesthetics.

• Improve and develop the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them. Improve and develop staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.