All inspections: Waters Green Dental and Implant Clinic

We undertook a follow-up, desk-based review of Waters Green Dental and Implant Clinic on 6 July 2020. This review was carried out to look in detail at the actions taken by the provider to improve the quality of care, and to confirm whether the practice was now meeting legal requirements.

The review was led by a CQC inspector with remote access to a specialist dental adviser.

We undertook a comprehensive inspection of Waters Green Dental and Implant Clinic on 12 February 2020 under section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

•Is it safe?

•Is it effective?

•Is it caring?

•Is it responsive?

•Is it well-led?

We found the provider was not providing safe and well-led care and was in breach of regulations 12, 16, 17, 18 and 19 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 Waters Green Dental and Implant Clinic on our website .

When one or more of the five questions are not met, we require the provider to make improvements. We then inspect again after a reasonable interval, focusing on the areas in which improvement was necessary. Due to the constraints in place because of the Covid-19 pandemic the review was desk-based. As part of the review we looked at the provider’s action plan and evidence sent to us to support the action plan.

As part of this review 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 identified at our inspection on 12 February 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 breaches we identified at our inspection on 12 February 2020.

Background

Waters Green Dental and Implant Clinic is near the centre of Macclesfield. The practice provides private dental care for adults and children.

There is level access to the practice for people who use wheelchairs and for people with pushchairs.

Car parking is available near the practice.

The dental team includes two dentists, a dental hygiene therapist, and three dental nurses. The practice has three treatment rooms.

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.

The practice is open:

Monday, Wednesday and Friday 9.00am to 5.00pm

Tuesday and Thursday 10.00am to 7.00pm

Our key findings were :

The provider had acted to reduce risks further in relation to fire, and the use of sharp instruments.
The provider had improved their recruitment processes and had obtained the required staff information.
The provider had acted to improve their systems for ensuring quality and safety in the practice, including in relation to checking of medical emergency equipment, safeguarding vulnerable adults and children, and communicating information to staff.
The provider had reviewed staff training. Staff had completed the training recommended by their professional regulator.
The provider had improved their systems for ensuring good governance. It was not possible at this stage to determine whether these improvements would be sustained in the longer term.

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

Improve the practice's systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular, consider action to be taken where staff Hepatitis B vaccination results are unknown or where staff have not yet completed the vaccination course.
Improve and develop staff awareness of the requirements of the Mental Capacity Act 2005 and Gillick competence and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

Take action to ensure all clinicians are aware and take account of relevant nationally recognised evidence-based guidance.
Take action to ensure the resulting improvements identified from carrying out audits can be demonstrated.
Improve the practice’s arrangements to ensure good governance and leadership are sustained in the longer term.

We carried out this announced inspection on 12 February 2020 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 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

Waters Green Dental and Implant Clinic is near the centre of Macclesfield. The practice provides private dental care for adults and children.

There is level access to the practice for people who use wheelchairs and for people with pushchairs.

Car parking is available near the practice.

The dental team includes two dentists, a dental hygiene therapist, and three dental nurses. Two locum dental hygienists and a locum dental nurse also work at the practice. The practice has three treatment rooms.

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 to both the dentists and the dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Friday 9.00am to 5.00pm

Tuesday 11.00am to 8.00pm

Wednesday 9.00am to 7.00pm

Thursday 9.00am to 8.00pm.

Our key findings were:

The practice was visibly clean.
The practice had infection control procedures in place which took account of some of the recognised guidance. The routine testing of the practice’s instrument sterilisers did not take account of the guidance.
The provider had safeguarding procedures in place. Staff knowledge of their responsibilities for safeguarding adults and children was inconsistent.
Appropriate medical emergency medicines were available. Some of the recommended medical emergency equipment was not available in the practice.
The provider had staff recruitment procedures in place but was not following them to ensure suitable staff were recruited.
Staff did not consistently take into account current guidelines when providing patients’ care and treatment.
The dental team provided preventive care and supported patients to achieve better oral health.
The provider did not ensure staff had completed recommended training, including in medical emergencies, in line with their professional regulator’s guidelines.
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 had a procedure in place for handling complaints. No information was provided to patients about how to make a complaint.
The practice had a leadership and management structure in place. There was little evidence of clinical or managerial leadership in the practice.
The provider’s systems for identifying and managing risk were ineffective.
Staff roles and responsibilities were unclear and staff lacked support for their responsibilities.
The provider had systems to support the management and delivery of the service, to support governance and to guide staff. These were not operating effectively.
Changes made as a result of previous inspections were not embedded or sustained. There were no mechanisms to help the practice continually improve.
The provider had limited means for asking patients and staff for feedback about the service.

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

Ensure care and treatment is provided in a safe way to patients.
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.
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 as is necessary to enable them to carry out their duties.
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 are considering enforcement action in relation to the regulatory breaches identified. We will report further when any enforcement action is concluded.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This means we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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

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 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.

Improve and develop staff awareness of the requirements of the Mental Capacity Act 2005 and Gillick competence and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
Take action to ensure all clinicians are aware and take account of current relevant nationally recognised evidence-based guidance.

We carried out a follow up inspection on 9 November 2017 at Waters Green Dental and Implant Clinic.

On 4 January 2017 we undertook an announced comprehensive inspection of this service as part of our regulatory functions. During this inspection we found breaches of the legal requirements. We carried out a follow-up inspection on 8 August 2017 to check whether the practice met the legal requirements in the Health and Social Care Act 2008 and associated regulations. During the inspection we found two of the breaches of the legal requirements had not been fully addressed.

A copy of the report from both these inspections can be found by selecting the 'all reports' link for Waters Green Dental and Implant Clinic on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice sent us an action plan outlining what they would do to meet the legal requirements in relation to the breaches. This report covers our findings in relation to those requirements only.

We revisited the practice on 9 November 2017 to confirm whether they had followed their action plan, and to confirm that they now met the legal requirements in the Health and Social Care Act 2008 and associated regulations. We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We reviewed the practice against oneof the five questions we ask about services: is the service well-led?

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

Our findings were:

Are services well-led ?

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

Background

Waters Green Dental and Implant Clinic is a general dental practice located near the centre of Macclesfield. There is level access to facilitate entrance to the practice for people who use wheelchairs and for pushchairs. Car parking is available near the practice.

The practice provides private dental services for adults and children.

The practice is open:

Monday 9:00am - 5:00pm

Tuesday 11:00am - 8:00pm

Wednesday 9:00am to 5:00pm

Thursday 11:00am to 8:00pm

Friday 9:00am to 5:00pm.

The practice team includes a principal dentist, an associate dentist, a hygiene therapist and three dental nurses. One of the dental nurses is currently training to be the practice manager.

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.

Our key findings were:

The practice had improved their systems to help them monitor and improve the service, for example, they now had robust processes in place in relation to significant events.
The practice had a leadership and management structure. Staff felt involved and supported and worked well as a team.
The practice had systems in place to help them assess risk. Measures to reduce risk had been improved.
The practice had improved their staff recruitment procedures.

We carried out a follow up inspection on 8 August 2017 at Waters Green Dental and Implant Clinic.

On 4 January 2017 we undertook an announced comprehensive inspection of this service as part of our regulatory functions. During this inspection we found breaches of the legal requirements.

A copy of the report from our comprehensive inspection can be found by selecting the 'all reports' link for Waters Green Dental and Implant Clinic on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches. This report only covers our findings in relation to those requirements.

We revisited the practice on 8 August 2017 to confirm whether they had followed their action plan and to confirm that they now met the legal requirements in the Health and Social Care Act 2008 and associated regulations. We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We reviewed the practice against one of the five questions we ask about services: is the service well-led?

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

Our findings were:

Are services well-led ?

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

Background

Waters Green Dental and Implant Clinic is a general dental practice located near the centre of Macclesfield. There is level access to facilitate entrance to the practice for people who use wheelchairs and for pushchairs. Car parking is available near the practice.

The practice provides private dental services for adults and children.

The practice is open:

Monday and Friday 9.00am to 5.00pm

Tuesday 11.00am to 8.00pm

Wednesday 9.00am to 7.00pm

Thursday 9.00am to 8.00pm.

The practice team includes a principal dentist, an associate dentist, a hygiene therapist and three dental nurses. One of the dental nurses is currently training to be the practice manager.

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.

Our key findings were:

The practice had systems in place to help them monitor and improve the service.
The practice had a detailed procedure in place for dealing with complaints.
The practice had a leadership structure. Staff felt involved and supported and worked well as a team.
The practice monitored staff training to ensure essential training was completed.
The practice had systems in place to help them assess risk but measures to reduce risk were not fully in place.
The practice had staff recruitment procedures in place, but these could be improved.

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 was not meeting are at the end of this report.

We carried out an announced comprehensive inspection on 4 January 2017 to ask the practice the following key questions; are services safe, effective, caring, responsive and well-led?

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 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

Waters Green Dental and Implant Clinic is located close to the centre of Macclesfield and comprises a reception and waiting room, and a treatment room all at ground floor level. Parking is available on nearby streets and in car parks. The practice is accessible to patients with disabilities, limited mobility, and to wheelchair users. The provider has been providing a dental service at this location since 2013.

The practice provides general dental treatment to patients on a privately funded basis. The practice is open Monday and Friday 9.00am to 5.00pm, Tuesday 11.00am to 8.00pm, Wednesday 9.00am to 7.00pm, Thursday 9.00am to 8.00pm and Friday 9.00am to 5.00pm. The practice is staffed by a principal dentist, a dental hygienist/therapist and two dental nurse / receptionists.

The principal dentist is registered with the Care Quality Commission as an individual. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We received feedback from five people during the inspection about the services provided. Patients commented that they found the practice excellent and that staff were professional, helpful and responsive. Patients commented that the practice was clean and comfortable.

Our key findings were:

There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
Staff had been trained to deal with medical emergencies, and emergency medicines and equipment were available.
The premises and equipment were clean and secure.
Patients’ needs were assessed, and care and treatment were delivered, in accordance with current legislation, standards, and guidance.
Patients received information about their care, proposed treatment, costs, benefits, and risks and were involved in making decisions about it.
Patients were treated with kindness, dignity, and respect, and their confidentiality was maintained.
The appointment system met the needs of patients, and emergency appointments were available.
Reasonable adjustments were made to enable patients to receive their care and treatment.
Staff were supervised, felt involved, and worked as a team.
Governance arrangements were in place for the running of the practice but were not all operating effectively.
The practice did not have a procedure in place to record and analyse significant events and incidents.
Staff were aware of the processes to follow to raise concerns, but had not received safeguarding training.
Staff followed current infection control guidelines for decontaminating and sterilising instruments but sterilisation equipment was not always checked for proper functioning.
Staff were supported to deliver effective care, and opportunities for training and learning were available but the provider did not monitor this to ensure essential training had been completed.

We identified regulations that were not being met and the provider must:

Ensure arrangements are implemented to receive and respond to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency and through the Central Alerting System, as well as from other relevant bodies such as, Public Health England.
Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
Ensure the practice’s infection control procedures and protocols are suitable having due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
Ensure waste is segregated and disposed of in accordance with relevant regulations and having due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01), specifically in relation to gypsum and local anaesthetic cartridges.
Ensure that the practice is in compliance with its legal obligations under the Ionising Radiations Regulations 1999 and Ionising Radiation (Medical Exposure) Regulations 2000.
Ensure the quality and safety of the service is assessed and monitored, for example, by carrying out regular audits of various aspects of the service, such as radiography and infection control. The provider should also ensure that audits have documented learning points, where relevant, and resulting improvements can be demonstrated.
Ensure an effective system is implemented for the recording, investigating and reviewing significant events and complaints with a view to preventing further occurrences and ensuring that improvements are made as a result.
Ensure staff are up to date with their training and their continuing professional development to support dental professionals in meeting the requirements of their regulator, the General Dental Council.
Ensure robust procedures to protect people are implemented and ensure all staff are trained in safeguarding children and vulnerable adults to an appropriate level for their role and aware of their responsibilities.
Ensure recruitment procedures are operated effectively in accordance with Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and ensure employment checks are carried out for all staff and the required specified information in respect of persons employed by the practice is available.

There were areas where the provider could make improvements and should:

Review the storage of dental care records to ensure all components are stored securely.
Review the practice’s complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by patients.
Introduce a system to seek the views of stakeholders about all aspects of service delivery.

Waters Green Dental and Implant Clinic

All Inspections

06 Jul to 06 Jul 2020

During an inspection looking at part of the service

12/02/2020

During a routine inspection

09/11/2017

During an inspection looking at part of the service

08/08/2017

During a routine inspection

4 January 2017

During a routine inspection