We carried out an announced focused inspection on 15 November 2016 to follow up on a previous inspection carried out on 25 May 2016 to ask the questions, are services safe?

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations

Background

We inspected the practice on 25 May 2016 and asked the provider to make improvements regarding Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment. We checked these breaches as part of the focused inspection on 15 November 2016.

The practice provides dental services to both adults and children. The practice provides mostly NHS treatment (90%). Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment. Patients also have the option of private treatment options such as implants and cosmetic dentistry.

The practice’s opening hours are – Monday 9am to 6pm, Tuesday 8.30am to 6pm, Wednesday 8.30am to 8pm, Thursday 8.30am to 5.30pm and Saturday by appointment only.

Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message or by telephoning the 111 NHS service.

The principal dentist/owner 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 practice has three dentists one of which is a first year foundation training dentist; one qualified dental nurse, three student nurses, two receptionists, and a practice manager.

Our key findings were:

• The treatment rooms were visibly clean and tidy, and had defined clean and dirty zones.
• The building had been maintained to a suitable standard for a dental practice.
• The practice carried out radiography practices in line with current regulations.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
• Portable appliance testing had been carried out
• The practice had a full and comprehensive Control of substances hazardous to health (COSHH) folder and staff were aware of its contents.
• All staff had completed Mental Capacity Act training

We carried out an announced comprehensive inspection on 25 May 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

Luton Arches Dental is a dental practice providing mostly NHS dental treatment, with private treatment options for patients. The practice is located in premises close to Chatham town centre.

The practice has three treatment rooms, one of which is on the ground floor.

The practice provides dental services to both adults and children. The practice provides mostly NHS treatment (90%). Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment. Patients also have the option of private treatment options such as implants and cosmetic dentistry.

The practice’s opening hours are – Monday 9am to 6pm, Tuesday 8.30am to 6pm, Wednesday 8.30am to 8pm, Thursday 8.30am to 5.30pm and Saturday by appointment only.

Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message or by telephoning the 111 NHS service.

The principal dentist/owner 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 practice has three dentists one of which is a first year foundation training dentist; one qualified dental nurse, Three student nurses, two receptionists, and a practice manager.

We provided CQC comment cards prior to our visit and received 14 completed cards. All were positive about the care and treatment received at the practice. We also spoke with patients and reviewed feedback that practice had received through the NHS Friends and family test (FFT) and NHS Choices.

Our key findings were:

• The treatment rooms were was visibly clean and tidy, but lacked defined clean and dirty zones.

• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients at the practice gave positive feedback about their experiences at the practice.
• Patients said they were treated with dignity and respect.
• Dentists identified the different treatment options, and discussed these with patients.
• Patients’ confidentiality was maintained.
• The building was not maintained to a suitable standard for a dental practice.
• The practice did not carry out radiography practices in line with current regulations.
• The practice did not follow some of the the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
• The practice had the necessary equipment for staff to deal with medical emergencies, and staff had been trained how to use that equipment. This included an automated external defibrillator, oxygen and emergency medicines.

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

• Ensure the practice’s infection control procedures and protocols are suitable giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Ensure the practice undertakes a Legionella risk assessment and implements the required actions giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000You 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:

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances