We carried out an announced comprehensive inspection of this practice on 15 October 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the following key questions; Are services safe and well-led?

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. 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 Hockwell Dental Surgery 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

CQC inspected the practice on 15 October 2015 and asked the provider to make improvements regarding infection control, equipment maintenance and servicing, safe use of X-ray equipment, security of the unmanned reception area, monitoring of the medicine fridge temperature, storage and transportation of waste, risk assessments for fire, Legionella and control of substances hazardous to health, implementation of clinical audits, regular review of policies and appropriate disclosure and barring service checks for clinical staff . We checked these areas and found these had been resolved, and significant work had been undertaken in the improvement of the service.

The principal dentist 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.

Our key findings were:

• Infection control procedures met the standard set out in the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices.’ published by the Department of Health.

• Steps had been taken to address the concerns raised by the reception area being unmanned whilst treatment was carried out in the treatment room.

• Comprehensive risk assessments had been carried out regarding Legionella (a bacterium that can contaminate the water supply of buildings) and fire. The practice had implemented a risk assessment in regard of the Control of Substances Hazardous to Health 2002 Regulations.

• Disclosure and barring service checks had been carried out on all clinical staff and Hepatitis B inoculation status reports were on record for all clinical staff.

We carried out an announced comprehensive inspection on 15 October 2015 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

Hockwell Dental Surgery provides primary dental care to adults and children. The practice provides mainly (95%) NHS treatment, with a small amount of private dentistry to patients in the Leagrave area of Luton in Bedfordshire.

The practice is open from 9am to 1pm and 2pm to 5.30pm on Mondays, Tuesdays, Thursdays and Fridays. They also provide evening appointments until 8pm on Tuesdays. The practice is closed on Wednesdays.

The practice has one dental surgery and is based in the converted ground floor of a house. There is a waiting room, and a separate decontamination room for the cleaning and sterilising of instruments.

The practice is one of three locations owned and run by a principal dentist. The practice is staffed by an associate dentist and dental nurse. The principal dentist spends approximately 5% of their time at the practice. Staff from the other locations provides cover for absence and leave.

The principal dentist is the registered manager and they were not working in the practice on the day of the inspection. They attended the inspection for approximately 15 minutes. 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.

We spoke with three patients during our visit, who told us that they were extremely happy with the service provided to them, and that the staff were always welcoming and friendly. They commented that their options regarding treatment were always explained to them including the cost of treatment, and that the practice is always clean and tidy. In addition we received 17 comment cards from patients who had completed these prior to inspection. All of the comments were complimentary about the practice and particularly the staff.

Our key findings were:

• The practice was visibly clean and tidy, with uncluttered surfaces.

• 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).

• Patients were involved in decision making about their care and treatment.

• We observed the staff were kind and caring and helped to put patients at their ease.

• The practice ensured staff maintained the necessary skills and competencies to support the needs of patients.

• Some risk assessments had been completed to maintain patient safety but others were missing.

• There were procedures and policies in place but they had not been reviewed.

• The practice had appropriate equipment and medicines to respond to a medical emergency in line with British National Formulary guidance.

• Some equipment had not been serviced and maintained regularly.

• The practice sought feedback from their patients.

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

• Ensure care and treatment is provided in a safe way. This includes reviewing the Health Technical Memorandum 01-05 (HTM01-05) with regards to the assessment of residual debris and water temperatures when cleaning equipment. They must carry out weekly protein residue tests on the decontamination equipment as outlined in HTM01-05. All equipment must be maintained and serviced in accordance with the manufacturers’ instructions. They must follow the correct processes for the use of X-ray equipment under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000. The security of the unmanned reception area must be reviewed to ensure the emergency drugs, equipment and patient information are kept in a secure location at all times. They must monitor the medicines fridge temperature to ensure temperature sensitive medication is correctly stored in order to remain viable. The storage and transportation of waste amalgam must be reviewed to reduce the risk of pollution of the environment and harm to human health.

• Ensure that there are good governance systems and processes in place to improve the quality and safety of the services. The provider must carry out appropriate risk assessments for those areas lacking, for example, fire risk assessments, control of substances hazardous to health and an external legionella risk assessment. They must complete clinical audits, for example, of record keeping and X-ray quality to identify if care and treatment is provided in line with recommended standards, if it is effective and where improvements could be made. All policies must be reviewed periodically and the provider must develop policies for the areas that are lacking, in particular safeguarding vulnerable adults.

• Ensure that all clinical staff have criminal records checks through the Disclosure and Barring Service (DBS)

You can see full details of the regulations not being met at the end of this report.

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

• Develop a business continuity plan to give staff guidance on what to do in the event of an emergency that effects the provision of the service.

• Carry out fire evacuation drills so staff know what to do in the event of a fire.

• 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.

• Consider the use of ‘safer sharps’ as per Health and Safety (sharp Instruments in Healthcare) Regulations 2013.

• Provide evidence of the Hepatitis B immunisation status of all staff.

Have paediatric oxygen masks and portable suction available to use in the event of an emergency.