The Dental Practice Seaford

We undertook a follow up focused inspection of The Dental Practice Seaford on 30 January 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 The Dental Practice Seaford on 11 and 12 July 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, effective or well led care and was in breach of regulations, 9 (person-centred care), 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment), 17 (good governance), 19 (fit and proper persons employed) and 20 (Duty of Candour) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook a follow up focused inspection of The Dental Practice Seaford on 25 September 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 (safe care and treatment),17 (good governance) and 18 (requirements in relation to staffing) 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 The Dental Practice Seaford on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

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 breaches we found at our inspection on 25 September 2020.

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 25 September 2020.

Background

The Dental Practice Seaford provides NHS and private treatment for adults and children.

There is access for people who use wheelchairs and those with pushchairs via a side entrance and small step respectively. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes the principal dentist, two trainee dental nurses, one part time receptionist and a practice manager. The practice has two treatment rooms of which one was in use at the time of our inspection.

The practice is owned by a company 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 the Dental Practice Seaford is the principal dentist.

During the inspection we spoke with the principal dentist, one trainee dental nurse, 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 from 9am to 5pm

• Tuesday to Friday from 9am to 2pm

Our key findings were:

• The practice had ensured that care and treatment was provided in a safe way for service users.

• The practice had systems and processes in place to enable the registered person to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk. Improvements made still required time to be embedded within the running of the service to ensure they are sustained in the long term.

• The practice had improved the systems to ensure that persons employed in the provision of a regulated activity received such appropriate support, training and professional development as was necessary to enable them to carry out their duties.

• The practice ensured that a risk assessment was in place for when a dental dam is not used during root canal treatment.

• The practice had reviewed its procedures in relation to the Accessible Information Standard to ensure that the requirements are complied with.

We undertook a follow up focused inspection of The Dental Practice Seaford on 25 September 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 The Dental Practice Seaford on 11 and 12 July 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, effective or well led care and was in breach of regulation 9, person-centred care; 12, safe care and treatment; 13, safeguarding service users from abuse and improper treatment; 17, good governance; 19, fit and proper persons employed; 20, Duty of Candour 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 The Dental Practice Seaford on our website www.cqc.org.uk.

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

• Is it safe?

• Is it effective?

• Is it well-led?

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 and had not fully responded to the regulatory breaches we found at our inspection on 11 and 12 July 2019.

Are services effective?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 11 and 12 July 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 and had not responded to the regulatory breaches we found at our inspection on 11 and 12 July 2019.

Background

The Dental Practice Seaford provides NHS and private treatment for adults and children.

There is access for people who use wheelchairs and those with pushchairs via a side entrance and small step respectively. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes the principal dentist, one trainee dental nurse, one part time receptionist and a practice manager. The practice has two treatment rooms of which one is in use.

The practice is owned by a company 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 the Dental Practice Seaford is the principal dentist.

During the inspection we spoke with the principal dentist, the trainee dental nurse, 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 from 9am to 5pm

• Tuesday to Friday from 9am to 2pm

Our key findings were:

• The practice ensured that care and treatment of patients was appropriate and met their needs.

• Staff were aware of nationally recognised guidance and applied it appropriately to the patient care.

• Staff ensured that patients were protected from abuse and improper treatment.

• Staff understood and had systems in place to ensure that requirements relating to Duty of Candour were met.

• Recruitment procedures reflected current legislation and consistency in such procedures had improved.

• The practice had not done all that is reasonably practicable to assess and mitigate all necessary risks in relation to infection control procedures, risks associated with fire and the appropriate vaccination of staff.

• Systems and processes were not yet established to ensure good governance with the fundamental standards of care.

• Staff did not always receive such appropriate support and training to enable them to carry out the duties they are employed to perform.

• The practice had not reviewed the requirements as set out in the Accessible Information Standard.

We identified regulations the provider was not meeting. 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 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.

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 dentists are aware of the guidelines issued by the British Endodontic Society for the use of for root canal treatment; in particular ensuring that a risk assessment is in place for when a dental dam is not used.

• Review the practice’s protocols and procedures in relation to the Accessible Information Standard to ensure that that the requirements are complied with.

We carried out this announced inspection on 11 and 12 July 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 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

The Dental Practice Seaford is in East Sussex and provides NHS and private treatment to patients of all ages.

There is access for people who use wheelchairs and those with pushchairs via a side entrance and small step respectively. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes the principal dentist, one trainee dental nurse, one part time receptionist and a practice manager. The practice has two treatment rooms of which one is in use.

The practice is owned by a company 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 the Dental Practice Seaford is the principal dentist.

On the day of inspection, we collected feedback from 20 patients.

During the inspection we spoke with the principal dentist, the trainee dental nurse 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 from 9am to 5pm
• Tuesday to Friday from 9am to 2pm

Our key findings were:

• The practice appeared clean.
• The provider had infection control procedures which reflected published guidance.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• Improvements were required to the information governance arrangements.
• There were ineffective arrangements to deal with emergencies. Several items of medical emergency equipment were missing or had expired, and not all recommended drugs were present.
• The provider had limited systems to help them manage risk to patients and staff.
• The provider lacked knowledge and awareness of safeguarding issues and did not follow-up concerns in a suitable manner.
• The provider did not have thorough staff recruitment procedures.
• The provider was not aware of and therefore was not providing patients’ care and treatment in line with current guidelines.
• Some aspects of preventive care were provided but the provider was not aware of guidance to support the practice in promoting oral health and preventing oral disease.
• Leadership at the practice was ineffective.
• The practice’s systems and processes did not support a culture of openness and transparency.

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

• Ensure care and treatment is provided in a safe way to patients
• Ensure the care and treatment of patients is appropriate and meets their needs
• Ensure patients are protected from abuse and improper treatment

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

• Act in accordance with the Duty of Candour

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 and implement an audit for the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice’s protocols and implement procedures in relation to the Accessible Information Standard to ensure that that the requirements are complied with.