Dental and Medical Clinic in Barking

We carried out this announced inspection on 20 May 2019, 28 May 2019 and 11 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 Care Quality Commission (CQC) inspector who was supported by a specialist dental adviser.

The inspection was carried out jointly with the General Practice inspection team who reported separately on the medical services. Details of their findings can be found by selecting the 'all reports' link Dental and Medical Clinic in Barking on our website www.cqc.org.uk.

This report relates only to the dental services provided.

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 providing well-led care in accordance with the relevant regulations.

Background

Dental and Medical Clinic is in Barking town centre in the London Borough of Barking and Dagenham. The practice provides a wide range of dental and medical services. The practice provides service on a private, fee paying basis only and the majority of the service’s patients originate from Eastern European countries. Dental services are available to adults and children.

The practice is located on the ground floor in purpose-adapted premises. The practice has one dental treatment room,. There is step-free access to the practice. The practice is located close to public transport services.

The dental team includes two dentists, two dental nurses and one trainee dental nurse. The clinical team are supported by a receptionist and the practice manager.

The practice is owned by a company 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 Dental and Medical Clinic in Barking is the practice manager.

On the day of our inspection we received feedback from 33 patients.

During the inspection we spoke with one dentist, one dental nurse and the practice manager. We checked practice policies and procedures and other records about how the service is managed.

The practice is open seven days each week between 9am and 7pm.:

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures in place. Improvements were needed so that infection prevention and control audits were carried out every six months taking into account published guidance.
• Staff knew how to deal with emergencies. Improvements were needed to the arrangements to ensure that the recommended medicines and life-saving equipment were available. The two items that were not available were ordered promptly and were available shortly after the first day of our inspection
• The practice had systems to help them manage risk. The practice had suitable safeguarding processes and staff 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. Improvements were needed to the practice systems for monitoring referrals.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice had arrangements to deal with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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

• Review the practice’s audit protocols to ensure infection control audits are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.
• Review the practice’s protocols for referral of patients and ensure all referrals are monitored suitably.

This service is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Dental and Medical Clinic in Barking as part of our inspection programme. This service had not previously been inspected.

Dental and Medical Clinic in Barking provides a wide range of private dental and medical services. The inspection was carried out jointly with a dentist specialist adviser, however this report relates only to the medical and not the dental services provided.

We received 33 patient comments about the service (comment cards and people we spoke with). All were positive about their experience using the service.

Our key findings were:

• The service’s systems to assess, monitor and manage risks to patient safety required improvement, for example in respect of safeguarding and significant event training. The service had reliable systems for appropriate and safe handling of medicines. The service learned from, and made changes as a result of, incidents and complaints.
• The service assessed need and delivered care in line with current legislation, standards and evidence based guidance.
• Improvements were required in process for reviewing the effectiveness and appropriateness of the care provided through clinical audits.
• The service treated patients with kindness, respect and compassion, and patient feedback was positive about the service experienced.
• The service organised and delivered services to meet patients’ needs.
• There was a clear leadership structure in place, and staff told us that they felt able to raise concerns and were confident that these would be addressed.
• The service had a governance framework in place, which supported the delivery of quality care, and processes for managing risks. There was some evidence of quality improvement measures.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure that care and treatment is provided in a safe way.

The areas where the provider should make improvements are:

• Review Legionella risk procedures to ensure the risk is effectively monitored and managed.

• Review processes for taking meeting minutes to communicate learning shared from complaints, significant events and feedback.

• Review systems and processes for quality improvement including a programme of audits.

You can see full details of the regulations not being met at the end of this report.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care