Archived: You Smile Dental Care

We undertook a focused inspection of You Smile Dental Care on 11 July 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 an inspection manager.

We undertook a focused inspection of You Smile Dental Care on 13 May 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 You Smile Dental Care 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 on13 May 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 breaches we found at our inspection on 13 May 2019.

Background

You Smile Dental Care is in Market Rasen, a town within the West Lindsey district of Lincolnshire. It provides private dental treatment to adults and children.

Treatments offered include general dentistry, orthodontics and dental implants.

There is level access into the practice and the treatment rooms. There is no car parking available on site although there is public car parking within short distance of the practice.

The dental team includes the principal dentist, a visiting implantologist, a qualified dentist who also undertakes the role of a hygienist and two dental nurses. The practice has two 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 with one dentist and one dental nurse.

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 7pm, Friday from 8.30am to 5pm and on some Saturdays with appointment only, from 9am to 4pm.

Our key findings were:

• Emergency medicines that had expired, had been replaced.

• Single use medical items were being used in accordance with manufacturers’ instruction.

• The provider had made policies available and staff were made aware of policy provision.

• The provider was reviewing their arrangements for significant event and untoward incident reporting to strengthen existing process.

• Computerised monitoring arrangements had been implemented which included overview of staff training requirements.

• A system was being introduced for staff appraisal and we saw some evidence of staff reviews that had taken place.

• We saw documentation relating to audit activity undertaken.

• Checks such as those for fire safety were now in place.

• We saw that a system for reviewing patient safety alerts had been implemented.

• Arrangements for lone working had been reviewed.

We carried out this unannounced focussed inspection on 13 May 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.

We undertook an inspection in response to concerns received.

We asked the following two questions:

• Is it safe?

• Is it well-led?

These questions form part of the framework for the areas we look at during a comprehensive 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 well-led?

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

Background

The practice is in Market Rasen, a town within the West Lindsey district of Lincolnshire. It provides private treatment to adults and children.

Treatments offered include general dentistry, orthodontics using the ‘Fast Braces’ orthodontist system and dental implants.

There is level access into the practice and the treatment rooms. There is no car parking available on site; there is public car parking within short distance of the practice.

The dental team includes the principal dentist, a visiting implantologist, a qualified dentist who also undertakes the role of a hygienist and two dental nurses. The practice has two 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 with one dental nurse who had been working in the practice for several years; they were the only member of the team present when we visited the practice. 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 7pm, Friday from 8.30am to 5pm and on some Saturdays with appointment only, from 9am to 4pm.

Our key findings were:

• The practice appeared clean.
• The provider did not have all infection control procedures that reflected published guidance.
• There was no evidence to confirm that staff had completed training in basic life support within the previous 12 months. Not all appropriate medicines and life-saving equipment were available. We found some emergency medicines had expired up to one year ago; these had not been replaced. Monitoring logs for emergency medicines were not completed accurately, but were signed off by staff as requiring no further action.
• There was no evidence on the day of our visit that all staff had indemnity to carry out their clinical roles. Evidence for current indemnity was provided for all staff after our visit.
• Single use items had been re-processed. These included items used for orthodontics treatments.
• There was no evidence on the day that all facilities and equipment were maintained, serviced, tested and safe to use. Some evidence was provided to us after the day.
• The provider had safeguarding policies and processes. Most documentation was undated, so it was unclear when it was last reviewed.
• The provider had staff recruitment procedures; however, references were not held for one member of the team and a Disclosure and Barring Service check (DBS) check was missing on another staff member’s file. The DBS certificate was sent to us afterwards.
• The practice had ineffective systems to manage risk to patients and staff.
• There were inadequate leadership 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.

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 practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.