We undertook a focused inspection of Genix Healthcare Dental Clinic – Alnwick on 15 April 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 remotely by a specialist dental adviser.

We undertook a comprehensive inspection of Genix Healthcare Dental Clinic – Alnwick on 20 November 2018 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 Genix Healthcare Dental Clinic – Alnwick 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 areas where improvements were 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 20 November 2018.

Background

Genix Healthcare Dental Clinic – Alnwick is in Northumberland and provides predominantly NHS treatment, and some private treatment, to adults and children. The dental practice was built in 2010 as part of the Genix Healthcare Ltd group of practices. Situated in a business park, the purpose-built practice has four treatment rooms, two of which are on the ground floor. There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team is comprised of five dentists, four trainee dental nurses, a practice manager who is also a qualified dental nurse, and two receptionists.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission 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 Genix Healthcare Dental Clinic – Alnwick is the practice manager.

During the inspection we spoke with the practice manager and the company’s area manager.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Wednesday 8.30am to 6pm

Tuesday and Thursday 8.30am to 7.30pm

Friday 9am to 5pm.

Our key findings were:

• The practice had effective leadership. Systems to help them manage risk to patients and staff had improved.
• The provider had improved their staff recruitment procedures.
• Policies were made practice specific and updated where needed.
• Recommended actions from the Legionella risk assessment were implemented.
• Hazardous substances were stored and labelled appropriately.
• Recent significant events were recorded and responded to appropriately.
• All dental equipment within the premises was checked to ensure it was compliant with regulations.

We carried out this announced inspection on 20 November 2018 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. This 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

Genix Healthcare Dental Clinic – Alnwick is in Northumberland and provides predominantly NHS treatment, and some private treatment, to adults and children. The dental practice was built in 2010 as part of the Genix Healthcare Ltd group of practices. Situated in a business park, the purpose-built practice has four treatment rooms, two of which are on the ground floor. There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team is comprised of four dentists, four trainee dental nurses, a practice manager who is also a qualified dental nurse, and two receptionists.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission 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. At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered.

On the day of inspection, we collected one CQC comment card filled in by a patient. This provided a positive view of the practice.

During the inspection we spoke with three dentists, two dental nurses, two receptionists and the practice manager. The company’s area manager was also present to support the inspection.

The practice is open:

Monday and Wednesday 8.30am to 6pm

Tuesday and Thursday 8.30am to 7.30pm

Friday 9am to 5pm.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 systems to help them manage risk to patients and staff needed improvement.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures in place; these required improvements.
• 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 were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The leadership within the organisation required improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable 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 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 system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice’s policies to ensure they are practice specific and accurate.

We carried out an announced comprehensive inspection on 20 September 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 providing well-led care in accordance with the relevant regulations.

Background

Genix Healthcare Dental Clinic – Alnwick

was established in 2010 as part of the Genix Healthcare Ltd group of practices. Situated in a business park, the purpose-built practice provides predominantly NHS treatment to patients of all ages. There are four treatment rooms, a ground floor reception, two waiting areas, two decontamination rooms for sterilising dental instruments, a staff kitchen and a general office. Ample car parking is available in front of the practice itself and within the entire business park. Access for wheelchair users or pushchairs is possible via the ramp outside and within the entire ground floor.

The practice is open Monday to Thursday 0800-2000, Friday 0900-1700 and Saturday 1000-1600.

The dental team is comprised of four associate dentists, six dental nurses (one being the senior lead) and two receptionists.

The practice provides general dentistry and is recruiting a fifth associate dentist who will be delivering conscious sedation within the premises.  The two ground floor treatment rooms will be used for this specialist treatment, with one of the rooms being designed and set up as a ‘recovery’ room for patients to recover fully following the sedation procedure.

The Genix healthcare limited company is the registered provider. A registered provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run. The practice has recently appointed a practice manager (who is currently the practice manager of another Genix dental practice within the region) and an application to be a registered manager for the premises has been initiated.

We reviewed four Care Quality Commission (CQC) comment cards on the day of our visit; patients were very positive about the staff and standard of care provided by the practice. Patients commented they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.

Our key findings were:

·      

The premises was visibly clean and free from clutter.

·      

An infection prevention and control policy was in place and sterilisation procedures followed recommended guidance.

·      

The practice had systems for recording incidents and accidents. 

·      

Practice meetings were used for shared learning.

·      

The practice had a safeguarding policy and staff were aware on how to escalate safeguarding issues for children and adults should the need arise.

·      

Staff received annual medical emergency training. Equipment for dealing with medical emergencies reflected guidance from the resuscitation council.

·      

The practice was actively involved in promoting oral health.

·      

Dental professionals provided treatment in accordance with current professional guidelines.

·      

Dental professionals were maintaining their continued professional development (CPD) in accordance with their professional registration.

·      

Patients could access urgent care when required.

·      

Patient feedback was regularly sought and reflected upon.

·      

Complaints were dealt with in an efficient and positive manner.

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

·       

Review the practice’s recruitment policy and procedures to ensure that all staff undergo

Disclosure and Barring Service (DBS)

checks prior to employment.

Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded.

·      

Review their practice, health and safety, legionella and fire risk assessments to ensure the action plans are fully implemented and documented when completed.

·      

Review practice policies to ensure they are not generic, are dated, regularly reviewed and updated as appropriate.

·      

Review the practice’s procedures for undertaking staff satisfaction surveys to help improve the quality of service.

People who used the service were provided with treatment to meet their individual needs by staff who were competent.

The provider had an effective recruitment and selection procedure in place and appropriate checks were carried out to ensure suitable staff worked within the practice.

Staff had received appropriate training and supervision to help them carry out their roles effectively.

We found there were appropriate systems in place to monitor and maintain the quality of the service and people were provided with information if they wished to make a complaint.

We spoke with six people who made positive comments about the service which included, “I’ve only had a couple of treatments here, but I’ve been happy – there’s been no pain and I’ve had no infections", “I’ve just had a filling and it was very good”, and “This dentist seems to know exactly what he’s doing and knows straight away what is wrong”. The records contained appropriate information about the patients and people said they were consulted and kept informed about their treatments. We concluded people's needs were assessed and care and treatment was delivered in line with their individual care plan.

People we spoke with said the practice was always clean. Comments included, "There's no problems with cleanliness", "It's very, very clean", "Oh it's clean, you can't fault it," and "It's spotless".

We found that people were protected from the risk of infection because appropriate guidance had been followed.

We concluded that people were protected from unsafe or unsuitable equipment.

We spoke with three people to find out their opinions of the treatment they had received. People told us they were involved in planning their treatment. One person told us, “She (the dentist) explained all the options. In fact we both decided what the best approach was.” We found that people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

Everyone we spoke with made positive comments and indicated they were pleased with the treatment they received. People described the treatment as, ”excellent” and “very good.” We found that people experienced care, treatment and support that met their needs and protected their rights.

We found that people who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People told us the practice was always clean. One person commented, “The cleanliness is faultless.” We saw the treatment rooms, decontamination rooms, waiting area and other communal areas were clean and tidy. We found that people were cared for in a clean, hygienic environment.

People told us they thought staff knew what they were doing. One person said, “The staff are very nice and attentive and very capable.” We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.