We carried out this announced inspection on 6 August 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 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 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
Redhill Dental Care is in Wellingborough, a town in Northamptonshire. It provides NHS treatment to children and private treatment to adults and children. Services provided include general dentistry, implant restoration and the practice has a contract with NHS England to provide orthodontic treatments to children. Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. Orthodontic treatment is provided under NHS referral for children except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment.
There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available directly outside the practice in a public car park.
The dental team includes one dentist, two dental nurses (one dental nurse works mainly as a receptionist) and a practice manager. The practice has two treatment rooms, although one is not currently in use and there is a separate decontamination room. They are on the ground floor level.
The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.
On the day of inspection, we collected 51 CQC comment cards filled in by patients.
During the inspection we spoke with the dentist, two dental nurses (including the dental nurse/receptionist) and the practice manager. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.
The practice is open: Monday to Friday from 9am to 5.30pm. The practice closes at lunchtimes between 1pm and 2pm.
Our key findings were:
- The practice appeared clean and well maintained.
- The provider had infection control procedures which reflected published guidance.
- Staff knew how to deal with emergencies. Appropriate medicines and most life-saving equipment were available. We noted some exceptions, for example, a child self-inflating bag and all recommended sizes of clear face masks were not available. Required items were ordered by the provider after the day.
- The provider had systems to help them manage most risks to patients and staff. We noted some exceptions, such as lone working and ensuring staff immunity to Hepatitis B was recorded.
- The provider had safeguarding processes and staff showed awareness of their responsibilities for safeguarding vulnerable adults and children.
- The provider had thorough staff recruitment procedures.
- The practice did not demonstrate that learning always took place when things went wrong.
- We were not assured that clinical staff always 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.
- We received a large number of positive comments from patients about the service and treatment received.
- Staff felt involved and supported and worked well as a team.
- Governance arrangements required strengthening.
- The provider asked staff and patients for feedback about the services they provided.
- The provider had systems to deal with complaints. No complaints had been received to date.
We identified regulations the provider was not complying with. They must:
- Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
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:
- Review the practice protocols regarding audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
- Review the practice protocols regarding auditing patient dental care records to check that necessary information is recorded.
- Review the practice’s protocols for the use of dental dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
- Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.