Woolton Dental Practice

We undertook a focused inspection of Woolton Dental Practice on 17 December 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Woolton Dental Practice on 11 June 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing safe or well-led care and was in breach of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Woolton Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

Our findings were:

Are services safe?

We found this practice was not providing safe care in accordance with the relevant regulations.

The provider had made insufficient improvements to put right the shortfalls we had previously identified and had not responded to the regulatory breaches we found at our inspection on 11 June 2019.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

The provider had made insufficient improvements to put right the shortfalls we had identified and had not responded to the regulatory breaches we found at our inspection on 11 June 2019.

Background

Woolton Dental Practice is located in south Liverpool and provides NHS and private treatment for adults and children.

There is level access for people who use wheelchairs and those with pushchairs. A small amount of car parking is available near the practice.

The dental team includes two dentists, three dental nurses, one trainee dental nurse/receptionist, and one dental hygienist,. The practice has four treatment rooms, two at ground floor level and two at first floor level. There is an additional treatment room on the ground floor, but this is not in use. The first floor is accessible via a staircase.

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.

During the inspection we spoke with the principal dentist, the dental hygienist, a dental nurse and the receptionist.

The practice opens and closes at different times each day. On Monday the practice is open from 9am to 1pm and from 2pm to 7.30pm. On Tuesday the practice opens from 8am to 12.30pm and from 1.30pm to 5pm. Wednesday the practice opens from 8.30am to 1pm and from 2pm to 5pm. Thursday the practice is open from 9am to 1pm and from 2pm to 5.30pm; and on Friday the practice opens from 8am to 12pm and from 1pm to 4.30pm. The practice also opens on Saturday to accommodate patient demand.

Our key findings were:

• Appropriate lifesaving equipment was available as required.
• Emergency medicines were available but adrenaline auto-injectors subject to a manufacturer recall had not been removed. There was no replacement adrenaline available in the practice. The provider took steps to address this following inspection.
• Systems to manage risk to patients and staff at the practice still required further improvement. Some improvement had been made to the reporting of significant events however, further work was required in this area to ensure learning for the provider and all staff involved.
• Staff had all undergone training in child safeguarding and safeguarding of vulnerable adults, to the required level.
• A recently recruited staff member could not explain what whistleblowing was and told us they had not been shown a whistleblowing policy.
• Systems to safely manage stocks of prescription pads were in place.
• The practice was still dispensing patient medicines without all the required information on the label of the container given to patients.
• Recruitment checks were not being carried out consistently. Records to support the recruitment process were not held as required. There was no evidence to show that the provider sought assurance of recruitment checks carried out in respect of locum staff, which were being relied on by the provider.
• There was no audit of antibiotic prescribing or of radiography in place.
• Governance in relation to radiation protection was still not adequate.
• Local rules for X-ray equipment at the practice remain insufficient; there was no named Radiation Protection Advisor (RPA) or Medical Physics Expert (MPE).
• The provider did not have oversight of the required continuing professional development for dentists who used X-ray equipment, or of training required for staff.
• The provider had not completed Mental Capacity Act training and no date was set for completion of this.
• There was no gas safety certificate available for the premises.
• Complaints were not being managed in line with NHS policy guidance.
• Communication within the practice between provider and staff, remains problematic, with no regular staff meetings in place. Medical alerts and updates were printed off by the provider, but these were not routinely shared with staff at the practice.
• Staff have experienced problems in relation to receiving wages due to them from the provider. We understand that this has been a factor in some staff leaving and other staff failing to report for duty. This has impacted on appointment availability for patients.
• Staff have complained of running out of consumables necessary for their daily work.

We identified regulations the provider was not meeting. They must:

• 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.
• Ensure specified information is available regarding each person employed.

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

We carried out this announced inspection on 11 June 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 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 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

Woolton Dental Practice is situated in the area of Woolton, Liverpool. The service provides NHS and private treatment as well as NHS treatment for those aged under 18.

There is level access for people who use wheelchairs and those with pushchairs, which is provided via a portable ramp. Car parking spaces, including one space for blue badge holders, are available at the rear the practice.

The dental team includes seven dentists, six dental nurses, three of which are at various stages in their training, one dental hygienist, and three receptionists. The practice has four functioning treatment rooms, two at ground floor level and two at first floor level. The first floor is accessible via a staircase.

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 14 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, three dental nurses and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice opens and closes at different times each day. On Monday the practice is open from 9am to 1pm and from 2pm to 7.30pm. On Tuesday the practice opens from 8am to 12.30pm and from 1.30pm to 5pm. Wednesday the practice opens from 8.30am to 1pm and from 2pm to 5pm. Thursday the practice is open from 9am to 1pm and from 2pm to 5.30pm; and on Friday the practice opens from 8am to 12pm and from 1pm to 4.30pm.

Our key findings were:

• The practice appeared clean.
• Although the treatment areas were well maintained, some work identified as being required by other stakeholders still required completion. Building works that had started had come to a standstill.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, but many items of equipment were out of date.
• The practice had systems to help them manage risk to patients and staff. These were not routinely followed by all.
• The practice did not adequately report, record and investigate significant events to enable shared learning.
• Governance around radiation protection required improvement.
• Prescription pads were not monitored in accordance with NHS guidance. Dispensing of medicines to private patients did not follow recognised guidance.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had a staff recruitment policy in place but the evidence and records to support this were not available as required.
• 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 were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs. Patient feedback on the inspection day indicated that this could be improved.
• The practice lacked leadership in certain areas. Monitoring and oversight of continuous improvement and all governance processes required improvement.
• There was no regular practice meeting being held, which hindered good communication across the practice.
• Staff said they felt supported and worked well as a team.
• The provider asked patients for feedback about the services they provided but results from feedback were not collated.
• The complaints handling processes required improvement.
• Information governance arrangements were in place.
• The provider could not show us their statement of purpose, or that this had been updated following de-commissioning of a surgery.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.

• 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:

• Introduce protocols regarding the taking into account the guidance provided by the Faculty of General Dental Practice.

• Review safeguarding training delivered to staff to check that this includes training of safeguarding of vulnerable adults.

• Introduce and effective system to receive, record, share and discuss alerts and updates in relation to clinical practice.