Bramley Dental Practice - Main Street

We undertook a follow up focused inspection of Bramley Dental Practice – Main Street on the 10 February 2020. 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 Bramley Dental Practice – Main Street on 4 November 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 and well led care and was in breach of regulation 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 Bramley Dental Practice – Main Street on our website www.cqc.org.uk.

As part of this inspection we asked: Remove as appropriate:

• 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 providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breach we found at our inspection on 4 November 2019.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breach we found at our inspection on 4 November 2019.

Background

Bramley Dental Practice - Main Street is located in Bramley, Rotherham and provides NHS and private treatments to adults and children. The practice is a foundation dentist training practice.

Access for wheelchair users and pushchairs is via a portable ramp into the reception area. Car parking spaces are available near the practice.

The dental team includes a principal dentist, a foundation training dentist and seven associate dentists, 14 dental nurses (five of whom are trainees), one dental hygienist, two dental hygiene therapist and two receptionists and two practice managers. The practice has five treatment rooms.

The practice is owned by a partnership as a condition of registration must have a person registered with the CQC 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 Bramley Dental Practice – Main Street is the principal dentist.

During the inspection we spoke with principal dentist and the practice managers. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday and Tuesday 9am - 6pm, Wednesday to Thursday 9am - 5pm. Friday 9am - 1pm

Our key findings were:

• Legionella management systems reflected current guidance and risk assessment.
• Safer sharps systems reflected current regulations.
• Risk mitigation was in place for staff without Hepatitis B vaccination results.
• An effective system was in place to respond to patient safety alerts.
• Clinical waste management complied with published guidance.
• Recommendations made by the Radiation Protection Advisor had been acted upon.
• Systems to ensure staff employed continued to meet the professional standards was effective.
• Recruitment processes reflected current legislation.
• The process to audit implant placement was in progress.

We carried out this announced inspection on 4 November 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 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:

Are services safe?

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

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

Bramley Dental Practice - Main Street is located in Bramley, Rotherham and provides NHS and private treatments to adults and children. The practice is a foundation dentist training practice.

Access for wheelchair users and pushchairs is via a portable ramp into the reception area. Car parking spaces are available near the practice.

The dental team includes a principal dentist, a foundation training dentist and seven associate dentists, fourteen dental nurses (five of whom are trainees), one dental hygienist, two dental hygiene therapist and two receptionists and two practice managers. The practice has five treatment rooms.

The practice is owned by a partnership as a condition of registration must have a person registered with the CQC 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.

At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered. We saw evidence on the day of inspection which confirmed that registration was in progress.

On the day of inspection, we collected 35 CQC comment cards filled in by patients. All comments reflected favourably on the service provided.

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

The practice is open: Monday and Tuesday 9am - 6pm, Wednesday to Thursday 9am - 5pm. Friday 9am - 1pm

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had infection control procedures which reflected published guidance.
• Improvements could be made to ensure clinical waste was managed in line with guidance.
• Legionella management systems were not carried out in line with guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Systems to help them manage risk to patients and staff could be improved.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• There was limited evidence to confirm that recruitment procedures reflected current legislation.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The completion of patient care records could be improved.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• There was limited evidence to confirm that staff employed continued to meet the professional standards.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Leadership and oversight could be improved to ensure guidance, regulations and standards are being met.
• Quality assurance systems could be improved to follow guidance and for learning and improvement.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had 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
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed

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

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

• Take action to ensure the clinicians take into account the guidance provided by the Faculty of General Dental Practice when completing dental care records.