Grace Dental Care -Windlestone Road Also known as Dr Saqib Sabih Aslam and Dr Izza Saqib

We carried out this unannounced inspection on 09 September 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection, due to concerns received, 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 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:

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 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 not 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

Grace Dental Care – Windlestone Road is in Billingham and provides NHS treatment and private treatment to adults and children.

The premises are not accessible for people who use wheelchairs. Wheelchair users can be seen at the provider’s sister practice. On street parking is available near the practice.

The dental team includes three dentists, one dental nurse, a part-time practice manager and two receptionists. The provider is currently recruiting another dental nurse. The practice has two treatment rooms.

The practice is owned by a partnership 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 Grace Dental Care – Windlestone Road is one of the partners.

During the inspection we spoke with both the partners, one of whom is a dentist, a dental nurse, a 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 Friday 9am to 5pm.

Our key findings were:

• The practice appeared clean and the building was well maintained. Clutter and disorganisation were apparent throughout.
• The provider did not have infection control procedures which reflected published guidance.
• Staff did not know how to deal with emergencies. Immediate action had to be taken to obtain medical oxygen. Emergency medicines were available but two items had past their use-by date.
• The systems to help them identify and manage risk to patients and staff were ineffective. Risks identified during the inspection include: fire, recruitment, Legionella, gas safety and electrical safety.
• The provider did not have suitable safeguarding processes and some staff were unaware of their responsibilities for safeguarding vulnerable adults and children.
• The provider did not have thorough staff recruitment procedures.
• 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 supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt supported by the provider.
• There was a lack of oversight of the governance and management systems of the practice.
• The provider did not ask staff and patients for feedback about the services they provided.
• The provider’s systems to deal with complaints positively and efficiently were not effective.
• The provider had suitable 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.
• Ensure all premises and equipment used by the service provider is fit for use.
• Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

Full details of the regulations the provider is not meeting are at the end of this report.

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

• Implement an effective system for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.
• Take action to ensure the service takes into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.
• Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017. In particular, ensure the practice is registered with the Health and Safety Executive for working with radiation.