Archived: Spilsby Dental Surgery

We undertook a follow up desk-based inspection of Spilsby Dental Surgery on 13 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.

We undertook a comprehensive inspection of Spilsby Dental Surgery on 17 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 well-led care and was in breach of regulation 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 Spilsby Dental Surgery on our website www.cqc.org.uk.

As part of this inspection we asked:

• 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 (requirement notice only). We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

Our findings were:

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 17 June 2019.

Background

The practice is in the centre of Spilsby, a village in Lincolnshire. It provides NHS and private treatment to adults and children.

The practice is in a grade two listed building which has limitations on modernisations that can be made. There are two treatment rooms, both on ground floor level, a decontamination room, a reception area, waiting room, office, staff toilet and patient toilet facility. There is also a staff room on the first floor of the practice. Access to the building is through a side alley. Patients with limited mobility or those who use wheelchairs are assisted by staff members to open the door to the practice.

There is no car parking available on site; there is a pay and display car park with spaces for blue badge holders within close proximity of the premises.

The dental team includes: one dentist, one dental nurse, one trainee dental nurse, one dental hygienist and one receptionist. The current owner at the time of our follow up inspection of the practice, is a qualified dentist who oversees the management and administrative functions.

At the time of our inspection, the practice was owned by an individual. 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. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday from 8.30am to 5pm. It closes between 1pm and 2pm on those days during lunchtimes.

Our key findings were:

• Policies had been subject to update and were computerised. Staff had access to policies and details for lead contacts were displayed in the practice for staff to refer to.

• A process for undertaking staff appraisals had been implemented since our previous inspection.

• A monitoring log was in place to enable more effective tracking of staff’s continuing professional development and training.

• Audit activity and its resulting outcomes had been subject to discussion by staff in practice meetings.
• The provider had reviewed the requirements for legislative checks if new staff were recruited. This included contact with the agency that had been used when temporary staff had been supplied to seek assurance.
• Areas of risk had been subject to further review such as the use of sharps and the security of prescription pads.

• The dental chair that contained tears had been repaired with new upholstery.

• The Mental Capacity Act 2005 and Gillick competence had been subject to discussion amongst the team.

• Patient safety alerts were being received and actioned, if appropriate.

We carried out this unannounced inspection on 17 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 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

The practice is in the centre of Spilsby, a village in Lincolnshire. It provides NHS and private treatment to adults and children.

The practice is in a grade two listed building which has limitations on modernisations that can be made. There are two treatment rooms, both on ground floor level, a decontamination room, a reception area, waiting room, office, staff toilet and patient toilet facility. There is also a staff room on the first floor of the practice. Access to the building is through a side alley. Patients with limited mobility or those who use wheelchairs are assisted by staff members to open the door to the practice.

There is no car parking available on site; there is a pay and display car park with spaces for blue badge holders within close proximity of the premises.

The dental team includes: three dentists, one dental nurse, two trainee dental nurses, one dental hygienist and two receptionists. The owner of the practice, who is a qualified dentist oversees the management and administrative functions.

The practice is owned by an individual. 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 nine CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse, one trainee dental nurse, one receptionist and the owner of the practice. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Thursday from 8.30am to 5pm. It closes between 1pm and 2pm on those days during lunchtimes.

Our key findings were:

• The practice appeared clean.
• Whilst the provider had some infection control procedures which reflected published guidance, we noted areas for review and improvement to be made. For example, walls not being free from damage and abrasion in the treatment rooms and upholstery on one of the dental chairs that required repair.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of a child self-inflating bag with reservoir, clear face masks for the self-inflating bag and a child oxygen face mask with reservoir and tubing. We saw evidence that the items had been purchased after the inspection.
• The practice systems to help them manage risk to patients and staff which required review; for example sharps use and a risk assessment for the hygienist when they worked without chairside assistance. We were informed that action was taken after our visit.
• Safeguarding processes required review. Not all staff were aware of the lead for safeguarding and an up to date policy was not available. We were informed that processes had been reviewed after our visit.
• The provider had staff recruitment procedures, although some of these required strengthening, for example the recruitment of agency staff.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider did not demonstrate effective leadership and culture of continuous improvement.
• Staff worked well as a team; more management oversight was required.
• The practice had not sought any recent feedback from patients about the services they provided.
• The provider’s systems for managing complaints required a more formalised structure. It was not evident that learning was shared amongst the team.
• The provider had information governance arrangements.

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

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

Full details of the regulation/s the provider was not meeting are at the end of this report.

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

• Review staff awareness of the requirements of the Mental Capacity Act 2005 and the principle of Gillick competence and ensure all staff are aware of their responsibilities as it relates to their role.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.
• Review the procedures for the review of patient safety alerts to ensure that they are shared amongst the team.