Archived: Reading Dental Sedation Clinic

We carried out this announced inspection on 17 July 2017 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.

We told the NHS England team that we were inspecting the practice. They did not provide any information.

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 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

Reading Dental Sedation Clinic is in Reading and provides NHS and private treatment to patients of all ages.

There is access for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the rear of the practice.

The dental team includes the practice manager, three dentists, a sedationist, two dental nurses, one recovery nurse, one dental hygienist, and four receptionists. The practice has five 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.

On the day of inspection we collected 40 CQC comment cards filled in by patients and obtained the views of 12 other patients. This information gave us a positive view of the practice.

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

The practice is open 8am to 6pm Monday, 8am to 5pm Tuesday and Thursday, 8am to 4pm Wednesday and 8am to 2pm Friday.

Our key findings were:

• The practice appeared clean and well maintained.

• The practice had infection control procedures which reflected published guidance.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.

• The practice had systems to help them manage risk.

• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.

• 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.

• The appointment system met patients’ needs.

• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

• The practice asked staff and patients for feedback about the services they provided.

• The practice dealt with complaints positively and efficiently.

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

• 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:

• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.

We carried out an announced comprehensive inspection on 30 March 2016 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

Reading Dental Sedation Clinic provides both a general dental service and a specialised sedation service for patients who require sedation to undergo dental treatments. The practice has been located in converted premises in Reading since the 1990’s. In 2004 the current principal dentist took over the practice and introduced the specialist sedation service. The practice carries out NHS treatments for patients under the age of 18 and for non fee paying adults. All other treatments are carried out on a private fee paying basis.

The principal dentist employs a practice manager and three receptionist/administrators. There are two associate dentists who work sessions at the practice. Sedation clinics are supported by a specialist anaesthetist. There was also a visiting dental hygienist working one session a week.

Due to the specialist nature of some of the services offered the practice did not open all day on every weekday. On Monday the practice was open from 8am to 6pm. From Tuesday to Thursday from 8am to 5pm and on Friday from 8am to 2pm.

The principal dentist is registered as an individual with the CQC. The dentist is therefore, responsible for the management of the service. 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 20 patients. Because we undertook our visit when one clinic was being held we were only able to speak with three patients who used the service. We also received 17 completed CQC comment cards. All 20 patients were complimentary and positive about the services they received from the practice. They all said how caring the dentists and staff were and how their fear of dental procedures was reduced by the staff.

Our inspection identified that the practice was not meeting the requirements of Regulation 17, Good Governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 The practice had failed to identify and take action on the risks posed by not complying with current guidance regarding reviewing processes to reduce the risk of cross infection at proscribed intervals and ensuring risk assessment for potentially hazardous materials are up to date. Full details of the regulation not being met are at the end of this report.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• The provider had robust arrangements in place to deal with medical emergencies.
• Staff received training relevant to their roles and were supported in their continuing professional development.
• Patients’ needs were assessed and care was planned and delivered in line with general professional and other published guidance.
• Patient feedback was consistently positive about the care and treatment received from the dentists.
• The arrangements in place to protect patients from the risks posed by exposure to X-rays were mostly operated in accordance with regulations.
• Dental sedation was carried out effectively and the practice had received accreditation for these procedures.
• Governance arrangements were in place but were sometimes operated inconsistently.

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

• Ensure audits of control of infection are carried out at six monthly intervals and actions identified from the audits are recorded.
• Review the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure they are stored securely and that COSHH assessments are up to date.
• Review the equipment used to clean the practice and the storage of the equipment to check that it is fit for purpose
• Review the flooring in the treatment rooms taking into account current design standards with non-porous flooring that reduces the risk of cross infection.
• Ensure monitoring of cleaning standards is consistently undertaken.