We carried out an announced comprehensive inspection on 15 February 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?
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
High View Dental Practice has a principal dentist who works full time, two qualified dental nurses who are registered with the General Dental Council (GDC) and a practice manager who also works on the reception. The practice’s opening hours are 9am to 6pm on Monday, Wednesday and Thursday, 9am to 7.30pm on Tuesday and 8am to 1pm on Friday. The practice is closed for one hour each day at lunchtime.
Highview Dental Practice provides NHS and private dental treatment for adults and children. The practice has two dental treatment rooms on the ground floor. There is a separate decontamination room for cleaning, sterilising and packing dental instruments. There is also a reception, waiting area and three patient toilets on the ground floor.
Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received feedback from nine patients who provided a positive view of the services the practice provides. All of the patients commented that the practice was always clean, staff were efficient and friendly and the quality of care was good.
Our key findings were
- Systems were in place for recording significant events, accidents and safety alerts although there was no documentary evidence to demonstrate that learning outcomes had been discussed with staff.
- There were sufficient numbers of suitably qualified staff to meet the needs of patients.
- Patients were treated with dignity and respect.
- The practice was visibly clean and well maintained.
- Infection control procedures in place were not robust, staff were re-using some single use items, the practice’s infection prevention and control audits were not being completed on a six monthly basis and there was no evidence to demonstrate action had been taken to address issues identified. There was no evidence that one piece of equipment used in the decontamination process had been serviced and maintained.
- Emergency equipment for dealing with medical emergencies reflected published guidelines. Staff had completed annual update training regarding dealing with medical emergencies.
- The appointment system met the needs of patients and waiting times were kept to a minimum.
- Governance arrangements in place for the smooth running of the practice were not robust; the practice did not have a structured plan in place to continuously audit quality and safety including infection control and radiographs.
We identified regulations that were not being met and the provider must:
- Ensure systems and processes are operated effectively to assess and monitor the service and risks in accordance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This includes: implementing an effective audit system; meeting the requirements of the Control of Substances Hazardous to Health (COSHH) Regulations 2002; working in accordance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013; meeting the Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections; the management of medicines and equipment; servicing, maintenance and ongoing checks of equipment; ensuring staff remain up to date with their continuing professional development requirements; the management of effective fire safety training including the provision of fire drills; the on-going assessment and supervision of all staff employed and ensuring dental care records are maintained appropriately.
There were areas where the provider could make improvements and should:
- Review the practice’s responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010 and ensure an Equality Act audit is undertaken for the premises.
- Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
- 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.