We undertook a follow up focused inspection of Solid Rock Specialist Dental Practice - Doncaster on 18 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 had telephone access to a specialist dental adviser.

We undertook a comprehensive inspection of Solid Rock Specialist Dental Practice - Doncaster on 5 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 Solid Rock Specialist Dental Practice - Doncaster 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 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 5 November 2018.

Background

Solid Rock Specialist Dental Practice is in Doncaster and provides private routine dentistry, oral surgery and dental implants to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the rear of the practice.

The dental team includes the principal dentist, who is registered with the General Dental Council as an Oral Surgeon and three trainee dental nurses. The practice has three treatment rooms, one of which is out of commission. On occasion a locum dentist will cover holidays and sickness.

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 the principal 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 Friday 10:30am – 1:30pm and 5pm – 8pm

Saturday 9am – 1pm.

Our key findings were:

• Appropriate measures were taken to ensure Legionella management systems were in place and that these reflected the risk assessment.
• Appropriate measures were taken to ensure fire safety systems were in place and that these reflected the risk assessment.
• The Control of Substances Hazardous to Health (COSHH) process had been reviewed and appropriate risk assessments put in place.
• Systems to ensure patient safety alerts were received and acted upon were in place.
• A system was in place to identify, report and record significant incidents including awareness of Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2005 (RIDDOR).
• Appropriate staff checks were in place and reflected relevant legislation.
• Suitable security measures for patient care records were in place.
• Appropriate measures were taken to prevent accidental use of the instrument washer disinfector.
• A system to ensure policies and procedures were reviewed and updated at appropriate intervals was in place.
• The use of closed-circuit television (CCTV) was appropriately reflected by a policy and a privacy impact statement in line with published guidance.

We carried out this announced inspection on 5 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. 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

Solid Rock Specialist Dental Practice is in Doncaster and provides private routine dentistry, oral surgery and dental implants to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available at the rear of the practice.

The dental team includes the principal dentist, who is registered with the General Dental Council as an Oral Surgeon and three trainee dental nurses. The practice has three treatment rooms, one of which is out of commission. On occasion a locum dentist will cover holidays and sickness.

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.

On the day of inspection, we collected 9 CQC comment cards filled in by patients. We

were unable to speak to patients during the inspection as there was no one booked in for appointments.

During the inspection we spoke with the principal dentist and three trainee dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 10:30am – 1:30pm and 5pm – 8pm

9am – 1pm Saturday

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.
• Improvement was needed to have appropriate systems to help them identify and manage risks to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures. Improvements could be made in respect to staff document checks.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Improvements could be made to protect the privacy and personal information of their patients.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• There was a defined leadership role within the practice, staff felt supported and worked well as a team.
• The governance and management of the practice could be improved.
• The practice asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• Information governance arrangements did not reflect General Data Protection Regulations (GDPR) requirements.

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 protocols for the use of closed circuit television cameras (CCTV) taking into account the guidelines published by the Information Commissioner's Office.

We carried out a follow up inspection on 28 December 2016 of Solid Rock Specialist Dental Practice.

We had undertaken an announced comprehensive inspection of this service on 10 November 2016 as part of our regulatory functions and during this inspection we found two breaches of the legal requirements.

During the follow up inspection the practice produced an action plan detailing what they had prepared to meet the legal requirements in relation to the breaches. This report only covers our findings in relation to those requirements.

We checked whether they had followed their action plan to confirm that they now met the legal requirements.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well led?

A copy of the report from our last comprehensive inspection can be found by selecting the 'all reports' link for Solid Rock Specialist Dental Practice on our website at www.cqc.org.uk.

Our findings were:

Are services safe?

We found that this practice was providing safe 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

Solid Rock Specialist Dental Practice is situated in Doncaster. The practice offers private routine dentistry, oral surgery and implants.

The practice comprises of two treatment rooms, one X-ray room, a decontamination room, a waiting and reception area, staff facilities and a patient toilet.

There are two dentists (one is the registered manager), two trainee dental nurses and a part time locum dental nurse.

The practice is open between 10:30am – 1:30pm and 5:00pm – 8:00pm Monday to Friday,

9:00am -1:00pm Saturday.

The principal dentist 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.

Our key findings were:

• The practice had addressed issues relating to the management of medical emergencies on the premises having purchased an Automated External Device (AED).
• The practice had addressed issues relating to the transport of dental instruments within the practice having purchased additional equipment and reviewing existing procedures.
• The practice had completed an infection control audit and had developed an action plan to address any areas for improvement.
• The practice had addressed issues relating to the fire safety management by the implementation of a professional fire risk assessment and regular fire safety checks.
• The practice had applied a safe sharps system, staff received training; dentists were now responsible for the dismantling and disposal of local anaesthetic sharps.
• The practice had registered with the Medicines and Healthcare Products Regulatory Authority (MHRA) and embedded the process within the practice.
• The practice had embedded reporting processes for Reporting of Incidents, Death and Dangerous Occurrences Regulations 2013 (RIDDOR) within the practice and significant event reporting and analysis.
• The practice had produced appropriate induction processes to protect staff safety during training and work placement.
• The practice had implemented a Control of Substances Hazardous to Health (COSHH) folder, produced a practice COSHH risk assessment and began to assemble safety data sheets for all COSHH related materials held at the practice.
• The practice had produced a clinical governance policy which covered quality assurance and analysis for learning and improvement.

We carried out an announced comprehensive inspection on 10 November 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 not 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

Solid Rock Specialist Dental Practice is situated in Doncaster. The practice offers private routine dentistry, oral surgery and implants.

The practice comprises of two treatment rooms, one X-ray room, a decontamination room, a waiting and reception area, staff facilities and a patient toilet.

There are two dentists (one is the registered manager), two trainee dental nurses and a part time locum dental nurse.

The practice is open between 10:30am – 1:30pm and 5:00pm – 8:00pm Monday to Friday, 9:00am-1:00pm Saturday.

The principal dentist 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.

On the day of inspection we received 11 CQC comment cards providing feedback. Patients who provided feedback were positive about the care and attention to treatment they received at the practice. Comments included that patients felt they were involved in all aspects of their care and found the staff to be very pleasant and helpful. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment. We were unable to speak to any patients as there were no patients booked in for appointments on the day.

Our key findings were:

• The practice did not have appropriate systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of incident reporting and medical emergencies.
• The practice was visibly clean and uncluttered.
• Staff had received safeguarding training, but could not clearly explain how to recognise signs of abuse and how to report it. They had systems in place to work closely and share information with the local safeguarding team.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were not fully embedded in accordance with the published guidelines.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Treatment was well planned and provided in line with current best practice guidelines.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients commented that they were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The practice was not well-led, but staff felt involved and supported and worked well as a team.
• The governance systems were not effective and embedded.
• The practice sought feedback from staff and patients about the services they provided.
• There was a defined leadership role within the practice and staff felt supported.

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

• Introduce a risk assessment and action plan to mitigate the absence of an Automated External Defibrillator (AED).
• Introduce an effective fire risk management and safety check system.
• Introduce an effective process of transporting clean and dirty instrument to and from the decontamination room to bring the process in line with Health Technical Memorandum HTM 01-05, Decontamination in primary care dental practices.
• Introduce a risk assessment for using sharps, paying particular attention to the dental nurses handling and dismantling local anaesthetic syringes.
• Ensure appropriate measures are taken to receive and action Medicines and Healthcare Products Regulatory Authority alerts (MHRA) pertinent to the dental practice environment.
• Introduce policies and procedures to cover Reporting of Incident, Death and Dangerous Occurrences Regulations 2013(RIDDOR) and Significant Event reporting giving due regard to staff awareness and training.
• Introduce appropriate induction processes to protect staff safety during training and for new staff visiting on work placement. Review the current staff’s recruitment files and collate all documents required in schedule 3 of the regulations. Schedule 3 is the Information Required in Respect of Persons Employed or Appointed for the Purposes of a Regulated Activity.
• Introduce a Control of Substances Hazardous to Health (COSHH) assessment folder, produce COSHH risk assessments and obtain Safety Data Sheets for all COSHH identified materials to bring in line with COSHH Regulations 2002.
• Introduce a robust process of analysis for learning and improvement when auditing clinical and non-clinical areas of the practice.

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

• Review the practice’s protocols on Safeguarding awareness and provide refresher training for all staff.
• Review the practice’s Health and Safety policy and source a Health and Safety Law poster, ensure staff are familiar with the policy and reporting procedures.
• Review the process for monitoring levels of appropriate Personal Protective Equipment in the decontamination room required by staff whilst handling dirty instruments to bring the process in line with Health Technical Memorandum HTM 01-05, Decontamination in primary care dental practices.
• Review the practice processes for ensuring emergency lifesaving equipment is fit for purpose, paying attention to expiry dates.
• Review the practice answer machine and provide emergency out of hours contact details.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review and complete the practice risk assessments and ensure all staff are aware of the contents.
• Review the current process to ensure qualified staff have appropriate indemnity prior to working in the clinical environment.

People’s privacy, dignity and independence were respected. One person told us “I am always talked through everything prior to any treatment”.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

There were effective systems in place to reduce the risk and spread of infection and people were cared for in a clean, hygienic environment. However, the provider may find it useful to note that not all daily infection control procedures had been documented.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Criminal Records Bureau (CRB) checks had been carried out for each staff member.

The provider had an effective system to regularly assess and monitor the quality of service that people received. People who use the service and staff were asked for their views about their care and treatment and if those views were acted on.