Archived: Grange Green Dental Practice

We carried out an unannounced focused inspection on 17 October 2016 following concerns raised anonymously about infection control procedures at the practice.

Our findings were:

Are services safe?

We found that this practice was not providing safe care in accordance with the aspects of the relevant regulations which we inspected.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the aspects of the relevant regulations which we inspected.

Background

Grange Green Dental Practice is a private dental practice situated in a converted property in Billericay, Essex. The practice offers a range of preventative, general and cosmetic dental treatments to adults and children.

The practice has three treatment rooms, a combined waiting room and a reception area. Decontamination takes place within treatment a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

There is a small car park at the front of the building and on street parking is available. There is step free access to the premises.

The practice has a principal dentist, three dental nurses and one receptionist. Two dental hygienists provide services to the practice.

The provider is registered with the Care Quality Commission (CQC) as an organisation. The principal dentist is the registered manager Like registered providers; they are ‘registered persons’. Registered persons 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 practice is open on Monday and Tuesday from 8.30am to 5.30pm, Wednesday from 8.30am to 7pm, Thursday from 8.30am to 5pm and Friday 8.30am to 4pm. The practice closes between 1pm and 2pm for lunch.

Our key findings were:

• The practice did not have effective systems in place for sharing information. There were a range of policies and procedures in place in relation to several aspects of care; however staff who we spoke with were unable to demonstrate that they were aware of, understood or followed these.
• The practice had safeguarding policies and procedures in place and staff we spoke with were able to demonstrate that they understood their responsibilities to report concerns about the safety and welfare of patients.
• The practice had a whistleblowing policy. Staff we spoke with did not feel confident to report concerns without fear of recrimination.
• Processes to manage risks with respect to infection control were not effective. Staff we spoke with could not demonstrate that they fully understood or followed these procedures. Infection control procedures were not carried out in line with current guidelines and there were no arrangements for monitoring procedures.
• There were ineffective measures in place to assess and minimise the risk of legionella.
• There were ineffective processes in respect of assessing and mitigating risks to the health and safety of patients and staff.
• There were ineffective procedures in place for disposing of hazardous waste materials.
• The practice had the recommended range of medicines and equipment for dealing with medical emergencies. However some medicines were not stored correctly in line with the manufacturer’s instructions.
• There were ineffective arrangements for supervising and supporting staff to carry out their duties safely and in line with current guidelines.
• There were ineffective governance arrangements in place to assess, monitor and improve the quality and safety of services provided.

At the time of finalising the inspection report the dental provider had sold the dental practice and cancelled their registration. The enforcement action against the dental provider was therefore cancelled.

This was the second comprehensive inspection that we had carried out at Grange Green Dental Practice

On 28 April 2016, we carried out a comprehensive inspection of Grange Green Dental Practice. We found the practice was not providing safe, effective, and well led services.

As a result of the findings on the day of the inspection the practice was issued with enforcement notices for regulation 12 (safe care and treatment) and regulation 17 (good governance) requirement notices for regulation 19 (fit and proper person).

We carried out an announced comprehensive inspection on 25 July 2016 to see if the practice had improved.

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

Grange Green Dental Practice provides private dental treatment to patients of all ages. The principal dentist employs a trainee dental nurse, and two receptionists. A hygienist provides services to the practice. In addition to an outside cleaner, the nurse and receptionists cover some of the cleaning duties.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. Registered persons 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 practice is located close to a GP practice and a variety of shops in Grange Road. It is operated from a converted bungalow making it accessible to wheelchair users. The practice has three treatment rooms, a reception and waiting area. There is a decontamination room for cleaning, sterilising, and packing dental instruments, a room for developing X-rays, and a toilet suitable for disabled patients. There is an annex situated in the garden, providing facilities for a staff kitchen and rest area with, storage for materials and files. There is a small car park at the front of the building and on street parking is available.

We received feedback from 38 patients during the inspection process. We received 37 positive comments about the cleanliness of the premises, the empathy and responsiveness of staff, and the quality of treatment provided. We received one negative comment about the services provided. Patients told us that staff explained treatment plans to them well. Patients reported that the practice had seen them on the same day for emergency treatment. We did not have the opportunity to speak with patients on the day.

Our key findings were:

• The practice had made significant improvements following our inspection on 28 April 2016.

• The practice had systems in place to help ensure patient safety. These included responding to medical emergencies and maintaining equipment.
• The practice met the standards required to ensure compliance with Health Technical Memorandum 07-01 (HTM 07-01) and Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Patients’ care and treatment was planned and delivered in line with evidence-based guidelines, best practice, and current legislation.

• The practice had engaged the services of specialist trainers and the team had worked together to ensure that they knowledge to deliver safe, effective care and treatment.

• Patients received clear explanations about their proposed treatment and were actively involved in making decisions about it.

• Patients reported that they were treated in a way that they liked by staff.

• Appointments were easy to book and emergency slots were available each day for patients requiring urgent treatment.
• The practice recorded and collated feedback from patients to make improvements to the service provided.
• Staff had a limited understanding of the Mental Capacity Act; however, they had training arranged.

• The practice had implemented quality monitoring systems and had undertaken audits to ensure quality and safety for patients.

• The practice undertook appropriate pre-employment checks for all staff.

• Staff received regular support of their training needs and working practices.

There were areas where the provider could make improvements and should:

• Embed all new systems and processes to ensure that patients and staff are kept safe.

• Embed new systems to ensure effective document management ensuring that policies and procedures are reviewed regularly.

• Undertake regular infection control audits to ensure that the practice continues to meet the requirements detailed in The ‘Health Technical Memorandum 01-05: Decontamination in primary care dental practices’ (HTM01-05) published by the Department of Health
• Undertake a full risk assessment for Legionella disease and follow any recommendations identified.
• Update the web site to reflect that the practice does not undertake sedation services.

We carried out an announced comprehensive inspection on 28 April 2016 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 not providing safe care in accordance with the relevant regulations

Are services effective?

We found that this practice was not 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

Grange Green Dental Practice provides private dental treatment to patients of all ages. The principal dentist employs a dental nurse, two trainee dental nurses, and two receptionists. A hygienist provides services to the practice. In addition to an outside cleaner, the nurses and receptionists cover some of the cleaning duties.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. Registered persons 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 practice is located close to a GP practice and a variety of shops in Grange Road. It is operated from a converted bungalow making it accessible to wheelchair users. The practice has three treatment rooms, a reception and waiting area. There is a decontamination room for cleaning, sterilising, and packing dental instruments, a room for developing X-rays, and a toilet suitable for disabled patients. There is an annex situated in the garden, providing facilities for a staff kitchen and rest area with, storage for materials and files. There is a small car park at the front of the building and on street parking is available.

We received feedback from 43 patients during the inspection process. We received 42 positive comments about the cleanliness of the premises, the empathy and responsiveness of staff, and the quality of treatment provided. We received one negative comment about the services provided. Patients told us that staff explained treatment plans to them well. Patients reported that the practice had seen them on the same day for emergency treatment. We did not have the opportunity to speak with patients on the day.

Our key findings were:

• The practice did not have robust systems in place to help ensure patient safety. These included responding to medical emergencies and maintaining equipment.
• The practice did not meet the standards required to ensure compliance with Health Technical Memorandum 07-01 (HTM 07-01) and Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Patients’ care and treatment was not always planned and delivered in line with evidence-based guidelines, best practice and current legislation.

• All the staff were employed within the last eight months and did lack some of the skills, knowledge, and experience to deliver safe, effective care and treatment.

• Patients did not always receive clear explanations about their proposed treatment and but were actively involved in making decisions about it.

• Patients reported that they were treated in a way that they liked by staff.

• Appointments were easy to book and emergency slots were available each day for patients requiring urgent treatment.
• The practice did not record and collate feedback from patients to make improvements to the service provided.
• Staff had a limited understanding of the Mental Capacity Act and the importance of gaining patients’ valid consent to their treatment.

• The practice did not have robust quality monitoring systems and did not undertake any audits to ensure quality and safety for patients, including infection control.

• The practice did not undertake appropriate pre-employment checks for all staff.

• Staff did not receive regular support of their training needs and working practices.
• We were concerned that during our inspection a range of evidence or documents that we need to inspect were not made available to us.

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

• Ensure staff training and availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.
• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices, The Health, and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Ensure waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at intervals in accordance with published guidance to help monitor safety and improve the quality of service. Ensure all audits have documented learning points and the resulting improvements can be demonstrated.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

• Ensure the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure that systems and processes are established and operated effectively to safeguard patients from abuse.
• Ensure systems are put in place for the proper and safe management of medicines.
• Ensure an effective system is established to assess, monitor, and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure that a system is implemented for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

There were areas where the provider could make improvements and should:

• Regularly seek and collate feedback from patients and use it to monitor and improve the service provided.
• Review guidance such as that provided by the National Institute for Health and Care Excellence (NICE), the Better Oral Healthcare Toolkit and the Faculty of General Dental Practice record keeping guidance to support the dentist to maintain appropriate dental care records.

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