We carried out this announced focused inspection on 12 September 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

Astek Dental Centre received a comprehensive inspection on 6 February 2017 and we served a Requirement notice for Regulation 17-Good Governance.  

They required improvement in ensuring the service was assessed and monitored to ensure risks were mitigated and they improved the quality and safety of services provided. This included taking actions following risk assessments carried out for health and safety. 

After the comprehensive inspection, the practice wrote to us to say what actions they would take to meet the legal requirements in relation to the breaches.

We revisited Astek Dental Centre and checked whether they had followed their action plan.

We reviewed the practice against one of the five questions we ask about services: is the service well-led? This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Astek Dental Centre on our website at www.cqc.org.uk.

The inspection was undertaken by a CQC inspector who had access to a remote specialist dental adviser.

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 practice had thorough staff recruitment procedures.

• 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 carried out an announced comprehensive inspection on 6 February 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

Astek Dental operates from a converted commercial property and provides private dentistry for adults. The practice did not see children. The practice is situated in the town of Leatherhead Surrey. There are two dental treatment rooms and a separate room for the cleaning and reprocessing of dental instruments. The practice has an in-house dental laboratory that manufactures dental appliances such as dentures, crowns and bridges that form part of the patient’s dental treatment.

The practice employs three dentists, a clinical dental technician who can carries out the clinical stages of denture construction, one dental nurse and a practice manager who undertakes reception duties.

The practice opens Monday to Friday between 9.00am and 5pm.

There are arrangements in place to ensure patients receive urgent dental assistance when the practice is closed. This is provided by an out-of-hours service. If patients called the practice when it was closed, an answerphone message leaves a telephone number for patients to ring depending on their symptoms.

The practice owner is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Before the inspection we sent Care Quality Commission (CQC) comments cards to the practice for patients to complete to tell us about their experience of the practice. We collected 14 completed cards. All the comments from patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
• There were systems in place to reduce and minimise the risk and spread of infection.
• The practice had safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• There was a system in place for reporting incidents.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.
• The practice maintained a system of policies and procedures, however there were shortfalls within the system. This included files containing policies and procedures from several different compliance systems which led to confusion with respect to operating practice policies, procedures and protocols.

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

• Ensure the practice’s infection control procedures and protocols are suitable giving 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 the practice undertakes a Legionella risk assessment and implements the required actions giving 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 that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure that a policy is in place for dealing with vulnerable adults.

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

• Consider providing an annual statement in relation to infection prevention control required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance is prepared.
• Review the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure they are stored securely.