We carried out this announced inspection on 10 May 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 providing well-led care in accordance with the relevant regulations.

Background

Papineni Dental Practice is in South Woodham Ferrers, and provides NHS treatment to adults and children.

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

The dental team includes one dentist and one dental nurse. The practice has one treatment room.

The practice is owned by a partnership 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 Papineni Dental Practice was the principal dentist.

On the day of inspection we collected 52 CQC comment cards filled in by patients and spoke with two other patients.

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

The practice is open: Thursday from 9am to 6pm. Patients are referred to the sister practice in Benfleet or the 111 out of hours service when the practice is closed.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were mostly available with the exception of a paediatric reservoir bag and clear face masks which were immediately ordered.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice asked patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.

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

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice and review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review staff awareness of young people’s competency in relation to consent and ensure all staff are aware of their responsibilities in relation to this.
• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.

We carried out an announced comprehensive inspection on 2 November 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

The practice is located within a purpose adapted residential property in Benfleet, Essex and offers a range of NHS general preventative, restorative and cosmetic dental treatments to adult patients and children.

The practice is open between 9.15am and 5.15pm on Mondays to Fridays and between 9.15am and 12.15pm on Saturdays. The practice closes between 12.15pm and 2.15pm for lunch.

The principal dentist and one other dentist work at the practice. The dentists are supported by one dental nurse and two receptionists.

The practice is registered with the Care Quality Commission (CQC) as an organisation. The principal dentist is the registered manager. 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 one treatment room, a reception area and a waiting room. Decontamination takes place within the treatment room and a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are washed, inspected, sterilised and sealed in pouches ready for use again).

Our key findings were:

• The practice had a procedure in place for sharing relevant information, investigating and learning from complaints, safety incidents and accidents. However, staff were not aware of their responsibilities to report incidents.
• The practice was visibly clean. Infection control practices were not in accordance with current guidelines, reviewed or audited to test their effectiveness.
• Dental instruments were not cleaned or stored in line with the current guidance to help minimise risks of cross infection.
• Clinical waste including sharps and needles were not stored securely in line with current waste regulations.
• The systems in place to help keep people safe, including safeguarding vulnerable children and adults were not robust, understood or followed.
• The practice medicines and equipment for use in the event of a medical emergency were in line with current guidelines.
• Medicines were checked frequently to ensure that they were in date.
• Staff had not undertaken training in respect of their roles and responsibilities within the practice.
• Patients reported that they were very satisfied with their treatment and that staff were respectful and helpful.
• The practice could normally arrange same day emergency appointments and a routine appointment within a few days. Appointments were flexible to meet the needs of patients.
• The governance arrangements in place for the smooth running of the service were not affective. Risks to patients and staff were not assessed or managed.
• Audits and reviews were not carried out to monitor and improve services.
• Patient’s views were routinely sought to make improvements to the service where these were identified.

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

Ensure that there are systems in place to deliver safe care and treatment and to protect the health, safety and welfare of patients. This includes procedures to:

• 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’.
• The practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01)
• The training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.

• Systems are implemented in respect of 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.

Ensure that there are systems in place for monitoring and improving the quality and safety of services carried out at the practice. This includes:

• Implementing protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Carrying out audits of various aspects of the service, such as infection control and radiography at regular intervals to help improve the quality of service. Practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure that all staff undertake training appropriate to their roles and responsibilities within the practice.
• Keeping the practice policies and procedures under regular review so that they reflect the management of the practice and current relevant legislation and guidance.

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

Following our inspection the provider told us that they had made improvements to the service in relation to the concerns we identified. They submitted some documents in relation to the improvements made. However we are unable to assess the effectiveness of the improvements we have been told about or be assured that these improvements are ongoing and embedded into practice.

We will assess these improvements when we carry out a follow up inspection in line with our methodology.