We carried out an announced comprehensive inspection of Oxforce Limited on 24 November 2017 and found that the service was not meeting regulations and requirement notices were issued. On 9 May 2018 an announced focussed inspection was carried out to follow up on the requirement notices and found that the issues we identified at the previous comprehensive inspection had not been resolved. The full reports from these inspections can be found by selecting the ‘all reports’ link for Oxforce Limited on our website at ww.cqc.org.uk.

This inspection was an announced focused inspection carried out on 31 July 2018 to follow up on a warning notice the Care Quality Commission served on 18 May 2018 following the focussed inspection in relation to Regulation 17 (1) Good Governance of the Health and Social Care Act 2008. The practice was required to correct the regulatory breaches set out in the warning notice by 29 June 2018. At this inspection we found that the provider had taken action in respect of the warning notice.

Are services safe?

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

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Our key findings were:

• Infection prevention control processes met the requirements set out in the Health Technical Memorandum – HTM01-05.
• There was a process in place to ensure oversight that training and competencies were maintained.
• There were suitable governance frameworks in place to support the delivery of services.

We undertook a focussed follow up inspection on 9 May 2018 to check whether improvements to the service had been made. We found a continued breach of regulations.

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was not providing effective care in accordance with the relevant regulations.

Are services well-led?

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

We carried out an announced comprehensive inspection on 24 November 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led? We found the service was not meeting regulations and issued a requirement notice. We checked these areas as part of this follow up focused inspection and found this had not been resolved.

The premises are leased and shared with an orthodontic practice. The services are provided on the second floor.

There is aregistered manager in post. 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 service is run.

We did not speak to patients as part of this inspection.

Our key findings were:

• Some risks associated with the provision of services were well managed. However, there was not a full assessment of the potential risks posed by infection control.
• There were not adequate governance arrangements in place in aspects of the service. Specifically there was a lack of systems to identify and deliver staff training. This led to a lack of support for staff and a lack of monitoring in relation to their skills and knowledge.

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

• The registered person must ensure systems and processes are established and operated effectively to ensure they assess, monitor and mitigate all risks to patients and others who may be at risk.

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:

• Review systems for checking staff records for any vaccinations required to deliver care available for monitoring purposes.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 24 November 2017 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not always providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This was the first inspection undertaken at this service.

Oxforce Limited provides patients with oral and Maxillofacial surgery (Maxillofacial care is related to the diagnosis and treatment of patients with diseases affecting the mouth, jaws, face and neck). Patients can receive assessments during consultations and x-rays where necessary from shared services with an orthodontist practice on the same premises. Surgery is undertaken in the provider’s own room and using their own equipment. A dental nurse and personal assistant are employed. In addition a consultant anaesthetist is sub-contracted when conscious sedation is required (a form of anaesthesia that is an alternative to general anaesthetic).

The premises are leased and shared with an orthodontal practice. The services are provided on the second floor.

Our key findings were:

• The provider had systems in place to identify and learn from clinical practice in order to improve services where necessary.
• Some risks associated with the provision of services were well managed. However, there was not a full assessment of the potential risks posed by infection control.
• Prescribing was undertaken safely, although the storage of blank prescription forms was not appropriate.
• Assessments of patient’s treatment options and treatment planning were thorough and followed national guidance.
• The necessary checks required on staff who provide care were not in place.
• Patients received full and detailed explanations of any diagnoses and treatment options.
• The service was caring, person centred and compassionate.
• There were processes for receiving and acting on patient feedback.
• There were not adequate governance arrangements in place in many aspects of the service. This led to a lack of support for staff and a lack of monitoring in relation to their skills and knowledge.

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

• The provider must operate systems and processes effectively and ensure they assess, monitor and mitigate all risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activities.

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

• Review the complaints process to ensure patients understand the process and are aware of their rights.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice