We undertook a focused inspection of Clocktower Dental practice on 02 October 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 Clocktower Dental practice on 12 April 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 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 Clocktower Dental practice 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 were required.

As part of this inspection we asked:

• Is it well-led?

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 providing well-led care in accordance with the relevant regulations.

Background

Clocktower Dental Clinic is in Epsom and provides private treatment to patients of all ages.

There is no level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes 3 dentists, 2 trainee dental nurses 2 dental hygienists, therapists and 1 receptionist. The practice has 3 treatment rooms.

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 Clocktower Dentals the principal dentist.

During the inspection we spoke with 1 dentist, 1 dental hygienist, 1 receptionist/manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 8:30am–7pm

Tuesday 8:30am–6pm

Wednesday 8am–5pm

Thursday 8:30am–6pm

Friday 8am–4pm

Saturday Closed

Sunday Closed

Our key findings were:

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

• Introduce protocols regarding the prescribing and recording of antibiotic medicines taking into account guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.

We carried out this announced inspection on 12 April 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. We have told the provider to take action (see full details of this action in the Requirement Notices/ Enforcement Actions section at the end of this report).

Background

Clocktower Dental Clinic is in Epsom and provides private treatment to patients of all ages.

There is no level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes three dentists, one dental nurse, two trainee dental nurses, two dental hygienists and one receptionist. The practice has three treatment rooms.

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 Clocktower Dental Clinic was the principal dentist.

On the day of inspection, we spoke with four patients who were very happy with the service provided.

During the inspection we spoke with two dentists, one dental nurse, two dental nurse trainees and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 8:30am–7pm

Tuesday 8:30am–6pm

Wednesday 8am–5pm

Thursday 8:30am–6pm

Friday 8am–4pm

Saturday Closed

Sunday Closed

Our key findings were:

• The surgeries had some high level cleaning issues; however the practice appeared to be well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. However not all medicines and life-saving equipment were available.
• The practice had some systems to help them manage risk.
• The practice had suitable safeguarding processes.
• The practice did not have 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 did not have effective leadership. Some 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 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.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Ensure specified information is available regarding each person employed.

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 way staff are supported to make sure that staff are able to meet the requirements of the relevant professional regulator throughout their employment, such as requirements for continuing professional development.
• Consider reviewing the information held on the practice website regarding accessibility of the practice.
• Introduce protocols regarding the prescribing and recording of antibiotic medicines taking into account guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
• Review the practice’s policies to ensure all documents are providing the latest requirements and guidance.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
• Review availability of interpreter services for patients who do not speak English as a first language.
• Review the practice's audit tool and protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and patients notes are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

We carried out an announced comprehensive inspection on 25 April 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

Clocktower Dental Clinic is located above an opticians opposite the clock tower in the High Street Epsom, Surrey. The entrance to the practice is along a side walk off the High Street. At the entrance of the practice there is a steep stairway that is not suitable for people using wheelchairs. The practice displays a notice referring patients to local practices that have level access for patients using a wheelchair. The practice resides on one level and comprises of three treatment rooms, a decontamination room, an X-ray room, a waiting room, a reception room and two patient toilets for male and female. There is a fourth treatment room that is currently used for storage and no dental services are commissioned from the room. Parking is available at local public paying car parks.

The practice provides private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers, crowns and bridges and specialist services including dental implants. Visiting sedationists from a registered service provide conscious sedation.

The practice staffing consisted of three dentists (including the two partners that own the practice), two dental hygienists, three dental nurses (including one trainee dental nurse), a receptionist and a part time practice manager.

The practice opening hours are Monday from 8.00am to 7.00pm, Tuesday from 8:30am to 6:00pm, Wednesday from 8:00am to 5:00pm, Thursday from 8:30am to 6:00pm, Friday 8:00am to 4:00pm and some Saturday’s by arrangement only.

The practice manager is registered with the Care Quality Commission (CQC) as an individual. 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. Eleven patients provided feedback about the service. 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:

• 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).

• The practice had an ongoing programme of risk assessments and audits which were used to drive improvement.
• Patients were involved in their care and treatment planning so they could make informed decisions.
• There were effective processes in place to reduce and minimise the risk and spread of infection.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and child protection
• 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 were treated with dignity and respect and confidentiality was maintained.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• Patients indicated that the team were friendly, caring and provided a pain free service.
• Dentists and hygienists were up to date with their continuing professional development.
• There was a comprehensive induction and training programme for staff to follow which ensured they were skilled and competent in delivering safe and effective care and support to patients.

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

• Review the process for learning from incidents reported to prevent repeated recurrences.
• Review the record keeping protocols for sedation cases and ensure appropriately qualified and skilled staff are assisting in treatment provided under sedation.
• Review the process for conducting X-ray audits and follow up on any areas that need improving.

We carried out an inspection at Clocktower Dental practice to look at the care and treatment provided to patients who used the service. We interviewed three patients and, with their permission, observed one treatment session. We spoke with three staff who worked at the surgery, and reviewed nine patients' records.

The patients we spoke with were extremely happy with the service. They described the practice as a “Good place to come to” and said “The best thing about them is their skills.” They told us staff ensured they had given their consent to care and treatment in advance. Patients were aware of their treatment plans and had been given options about the treatment they received. We were told staff "Talk for ages" with them and the practice was "Excellent.”

We were told and observed that the premises were clean and that staff were seen to wear gloves and masks when they carried out treatments. People told us they did not have to wait for appointments, and were seen promptly in an emergency.

People told us they hadn’t noticed a complaints poster in the surgery but that was because they had never had a need to complain.

We were only able to talk to one person who used the service on the day of the site visit. We undertook telephone surveys of two further people to ascertain their views of the service.

People who used the service told us that staff at the service respected their privacy and dignity when they were having their treatment.

People told us that they were able to ask questions about their treatment and they were provided with different options that helped them make decisions about their treatment.

One person told us, “All my treatment was explained to me and I was provided with a treatment plan and an estimate of the cost for the treatment.”

Another person told us, “I am receiving an excellent service from a very competent Dentist and friendly staff.”