The Elms Dental Practice

We carried out this announced comprehensive inspection on 24 October 2022 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 practice 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 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:

• The dental clinic was visibly clean. However, we found shortfalls in the maintenance of the premises as there was no running hot water where staff hand washing took place and the 5 yearly fixed wire testing had not been completed since 2011. Following the inspection, the practice took immediate action to resolve these shortfalls.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available. We found that dental nurses supporting sedation treatments had not completed Immediate Life Support training with airway management.
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had staff recruitment procedures which mostly reflected current legislation. Not all clinical staff had an enhanced Disclosure and Baring Service (DBS) check in place.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Patients were treated with dignity and respect and staff 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.
• There was effective leadership and a culture of continuous improvement. We found that the practice had not completed antimicrobial prescribing audits.
• Staff felt involved and supported and worked as a team.
• Staff and patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• The dental clinic had information governance arrangements.

Background

The Elms Dental Practice is in Maldon, Essex and provides private dental care and treatment for adults and children. In addition to general dentistry, the practice provides a dental implant and sedation service from visiting specialists.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made reasonable adjustments to support patients with additional needs.

The dental team includes 1 dentist, 2 dental nurses including 1 trainee dental nurse, 1 dental hygienist, 1 dental therapist, 1 receptionist and the practice manager. The practice has 2 treatment rooms.

During the inspection we spoke with the dentist, 1 trainee dental nurse, the dental hygienist, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday from 9am to 5pm.

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

• Take action to ensure the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular, ensure 5 yearly electrical fixed wire testing is undertaken in line with guidance. Take action to ensure both hot and cold running water is available in areas where employees are expected to wash their hands taking into account the Workplace (Health, Safety and Welfare) Regulations, 1992.
• Take action to ensure that dental nursing staff who assist in conscious sedation have the appropriate training and skills to carry out the role, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015'.
• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the College of General Dentistry. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Improve the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff. In particular, ensure enhanced Disclosure and Baring Service checks are in place for all clinical staff.