We undertook a follow up focused inspection of ADF Clinic on 19 February 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 a specialist dental adviser.

We undertook a comprehensive inspection of ADF Clinic on 20 November 2017 and a follow up inspection on 25 September 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 safe or well led care and was in breach of regulations 12 (Safe Care and Treatment) and 17 (Good Governance) 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 ADF Clinic on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?
• 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.

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 inspections on 20 November 2017 and 25 September 2018.

Are services well-led?

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

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspections on 20 November 2017 and on 25 September 2018.

Background

ADF Clinic is in Clacton and provides private treatment for adult patients.

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

The dental team includes one dentist, one dental nurse, one visiting dental hygienist, one receptionist and the clinical manager. The practice has one treatment room.

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

The practice is open: Monday to Thursday from 11am to 6pm and Friday from 9am to 2pm.

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Systems were in place to ensure X-ray and decontamination equipment was maintained in line with manufacturers recommendations’.
• Legionella risk assessment had been undertaken. There was limited evidence that any recommended actions had been completed.
• Staff recruitment procedures were in place. There were no records to confirm staff Hepatitis B immunity.

We identified regulations the provider was not meeting. 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 is not meeting are at the end of this report.

​

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

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

We undertook a focused inspection of ADF Clinic on 25 September 2018. 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 a specialist dental adviser.

We undertook a comprehensive inspection of ADF Clinic on 20 November 2017 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 or well led care in accordance with the relevant regulations 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 ADF Clinic on our website www.cqc.org.uk.

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.

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 not providing safe care in accordance with the relevant regulations.

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 20 November 2017.

Are services well-led?

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

The provider had made insufficient improvements to put right the shortfalls and had not responded to the regulatory breaches we found at our inspection on 20 November 2017.

Background

ADF Clinic is in Clacton On Sea and provides private treatment to adult patients. There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes one dentist, one dental nurse, a clinical manager, and two receptionists. The practice has one treatment room.

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.

No patients were available to talk with during our inspection.

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

The practice is open: Monday to Thursday from 11am to 6pm and Friday from 9am to 2pm.

Our key findings were:

• The practice was not giving due regard to the tests and quality checks for the cone beam computed tomography (CBCT) machine. Following the inspection in September 2018 the provider confirmed no further scans would be taken until the CBCT had been serviced. We were then sent evidence to confirm a named radiation protection adviser had been appointed and maintenance and servicing of the CBCT had been scheduled for 9 November 2018.

• The practice had still not purchased an automated external defibrillator as highlighted at the inspection in November 2017. There was no risk assessment in place to ensure the practice had reviewed the risks of access to an AED. Following this inspection, the practice provided evidence that an AED had been purchased.

• We noted the practice had recorded daily checks to the oxygen at the practice. These checks had not highlighted that the oxygen cylinder was out of date and was due for replacement in June 2018.
• Emergency equipment and medicines were mostly available as described in recognised guidance. There was not a size 0 airway or a paediatric ambubag. We noted the packaging for the other airways was damaged and no longer airtight, therefore the other airways required replacing. In addition, we noted there was not an eyewash station or a first aid kit available at the practice. Following the inspection, the principal dentist sent us evidence that these had been replaced.
• Annual CPR training had been undertaken at the practice on 11 October 2017. However, the practice had recruited two new members of staff since then who had not undergone CPR training.

• A Legionella risk assessment had been undertaken at the practice on 29 January 2018. There was no action plan in place to monitor the areas that required addressing, when they had been addressed and when they were completed. Dip slide testing had not been undertaken.

• We found no records of DBS checks for any staff working at the practice, no evidence of recent GDC registration for clinical members of staff and no records of Hep B immunity in staff records.

• The practice had not moved to a system of safer sharps since the previous inspection in November 2017. Not all the staff we spoke with were aware of safe processes for the disposal of sharps.

• Sharps bins were signed and dated. Clinical waste was stored in a suitable locked bin in a secure area outside the practice.
• There was a system in place for receiving and acting on safety alerts to ensure the practice learned from external safety events as well as patient and medicine safety alerts.

• The practice had made some reasonable adjustments for patients with disabilities. These included step free access. There was no hearing loop available at the practice to assist patients who wore a hearing aid and no Equality Act risk assessment in place to assess where action would be required.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way for 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 systems for environmental cleaning taking into account current national specifications for cleanliness in the NHS.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

We carried out this announced inspection on 4 December 2017 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 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

ADF Clinic is in Clacton On Sea and provides private treatment to adult patients.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes one dentist, one dental nurse who is also the practice manager, and two receptionists. The practice has one treatment room.

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 three CQC comment cards filled in by patients, which gave us a positive view of the practice. No patients were available to talk with during our inspection.

During the inspection we spoke with the dentist and the two dental receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Tuesday to Wednesday from 1pm to 6 pm, Thursday from 12pm to 6pm and was closed on Monday and Friday open for emergency appointments only.

Our key findings were:

• The practice was clean and mostly well maintained.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice asked staff and patients for feedback about the services they provided.
• The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Staff knew how to deal with medical emergencies, although not all equipment recommended by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards was available.
• The practice’s systems to help them manage risk were not effective. For example the practice had not completed infection control risk assessments.
• Systems to ensure the safe recruitment of staff were not effective, as essential pre-employment checks had not been completed.
• Systems for checking expiry and servicing dates for equipment and medicines were not effective. Fridge temperatures were not being monitored. Instruments were not always pouched and some pouched instruments were not dated.
• The practice information governance arrangements were not effective as information and understanding of processes such as Legionella risk assessment, infection prevention and control, safe recruitment of staff and RIDDOR were not understood and embedded across the whole practice team.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way for 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 waste handling protocols to ensure waste is segregated and disposed of in accordance with relevant regulations taking into account guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System), as well as from other relevant bodies, such as Public Health England
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Review the practice’s responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

We did not have the opportunity to speak with people who used the service during our visit. We contacted some people the following day to get feedback from them. People we spoke with gave positive comments and said they would recommend the service.

Comments included: “I have been a patient for over a year, it’s a pleasant atmosphere, and you are always kept informed about the progress of your treatment.”

Records showed us that people were involved in decisions about their care and treatment options and related cost.

We found that the surgery was clean and tidy and that staff understood the cleaning procedures to be followed. We saw that there were effective systems in place to reduce the risk and spread of cross infection.

We found that the staff were appropriately trained and supported and that the provider had systems in place to ensure the quality and safety of the service provided.