Speke Dental Practice

We undertook a follow up desk-based inspection of Speke Dental Practice on 18 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 Speke Dental Practice on 26 November 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 Speke Dental Practice 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. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

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 26 November 2019.

Background

Speke Dental Practice is located in a purpose-built health centre in Speke, Liverpool and provides NHS treatment for adults and children.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for people with disabilities, are available near the practice.

The dental team includes two consultant oral surgeons, three dental nurses, and a practice manager. The practice has three treatment rooms. The third treatment room is used and maintained by a separate provider of dental treatment.

The practice is owned by a company and as a condition of registration must have a person registered with the CQC 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 Speke Dental Practice is the practice manager.

During the inspection we spoke with the practice manager. We looked at practice records about how the service is managed, and talked through the actions taken by the provider, since our last inspection.

The practice is open on approximately two Saturdays each month. Access is by appointment only.

Our key findings were:

• Accurate, complete and detailed records were maintained for all staff. The provider held all the required recruitment records for the two sedation dentists working at the practice, and for the dental nurses who worked with the sedation dentists.
• The practice manager could evidence effective oversight of required continuous development for clinicians.
• Equipment to manage medical emergencies was available. All equipment was checked daily, using a list of items as recommended by the Resuscitation Council (UK) and the General Dental Council. Medical oxygen sufficient for use in an emergency available.
• Revised protocols for the management of Legionella were in place. Evidence supplied by the practice showed that water temperature checks were in place and that temperatures recorded were in the required range.
• The practice whistleblowing policy had been updated to provide contact details of the Care Quality Commission and the General Dental Council.

We carried out this announced inspection on 26 November 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 Care Quality Commission, (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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

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

Are services well-led?

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

Background

Speke Dental Practice is located in a purpose-built health centre in Speke, Liverpool and provides NHS treatment for adults and children.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for people with disabilities, are available near the practice.

The dental team includes two consultant oral surgeons, three dental nurses, and a practice manager. The practice has three treatment rooms. The third treatment room is used and maintained by a separate provider of dental treatment.

The practice is owned by a company and as a condition of registration must have a person registered with the CQC 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 Speke Dental Practice is the practice manager.

On the day of inspection, we collected 83 CQC comment cards filled in by patients. All feedback provided was highly positive.

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

The practice operates on approximately two Saturdays each month. Access is by appointment only.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies.
• Not all of the recommended life-saving equipment was available. This was ordered on the day of our inspection.
• All recommended emergency medicines were available.
• The provider had systems to help them manage risk to patients and staff. Some of these required review.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures which reflected current legislation. All recruitment records were not held by the provider and were not available for inspection as required.
• 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.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership in place for the day to day management of the practice.
• Staff felt involved and supported and worked as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with any complaints positively and efficiently.
• 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.

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

• Improve the practice's systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular that all appliances connected to the water pipes servicing the dental treatment rooms are maintained as described in the Legionella risk assessment.