We carried out this announced inspection on 27 February 2019 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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

Park Clinic is in the Abington area of Northampton and provides private dental treatment to adults and children.

The practice provides an intravenous sedation service for nervous patients.

The practice offers a circumcision service mainly to children and infants for religious, cultural and medical reasons. This service is provided by a consultant urologist, although it had been voluntarily suspended by the provider to allow a review of the registration requirements.

There is stepped access with a removable ramp for people who use wheelchairs and those with pushchairs. There is roadside car parking in the area around the practice.

The dental team includes four dentists, three qualified dental nurses (including one locum nurse for sedation) and one trainee dental nurse. The practice has two treatment rooms, one of which is on the ground floor.

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 Park Clinic is the principal dentist.

On the day of inspection, we collected 29 CQC comment cards filled in by patients. We also received information from two other patients through the CQC website.

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

The practice is open Monday to Friday from 9am to 7pm and Saturday from 9am to 5pm. The practice is closed on Sunday.

Our key findings were:

• There were areas of the practice that did not appear clean.
• The provider had infection control procedures, however we identified some areas which did not reflect published guidance.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available.
• The practice had ineffective systems to help them manage risk to patients and staff.
• The provider had ineffective safeguarding processes and it was not clear if staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had significant gaps in the staff recruitment information required by the Regulations.
• Clinical waste segregation and identification was ineffective.
• Staff took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported.
• The provider asked patients for feedback about the services they provided.
• The provider had suitable information governance arrangements.
• The practice provided intravenous sedation for nervous patients, although this service had not been delivered since 2017.
• The practice provided a circumcision service mainly to children and infants for religious, cultural and medical reasons. This service was provided by a consultant urologist. The systems and processes for gathering consent in relation to circumcision were not effective.
• There was no formal system for the use of interpreter services in the practice.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are 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 staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.

• Review the availability of an interpreter service for patients who do not speak English as their first language.

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

We carried out an announced comprehensive inspection of this practice on 15 December 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 braches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) Regulation 12: Safe care and treatment; and Regulation 17: Good governance. 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 Park Clinic on our website at www.cqc.org.uk

We carried out an announced follow up inspection on 28 July 2016 to ask the practice the following key questions; Are services safe 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 well-led?

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

Background

Park Clinic is situated on the ground floor of premises in Northampton. The practice is accessible to patients with restricted mobility, such as those in a wheelchair. The practice provides regulated dental services to patients in Northampton and the surrounding area. The practice provides wholly private dental treatment. Services provided include general dentistry, dental hygiene, implants and sedation.

The practice was open: Mondays to Fridays: 9am to 7pm and 9am to 5pm on Saturdays.

Access for urgent treatment outside of opening hours was by ringing the practice telephone number and following the answerphone message.

The practice has one dentist and two dental nurses.

Our key findings were:

• Staff had been trained to deal with medical emergencies and the practice had the expected emergency equipment and medicines.
• Dental care records in relation to sedation had improved since the last inspection in December 2015. Those records were more detailed and clearer.
• Date sensitive equipment at the practice was being checked regularly and was within its use by date.
• The practice had all of the medicines needed for an emergency situation, as identified in the British National Formulary (BNF).
• X-ray equipment had been serviced and maintained as required by the Ionising Radiation Regulations 1999 (IRR 99).
• Information about the assessment, diagnosis, treatment and advice given to patients by the dentist was recorded in the dental care notes.

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

• Review the systems in place to assess and evaluate the quality of the service based on feedback from patients to make improvements in the practice.

We carried out an announced comprehensive inspection on 15 December 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

Park Clinic is situated on the ground floor of a premises on Wellingborough Road

in Northampton. The practice is accessible to patients with restricted mobility, such as those in a wheelchair. The practice was registered with the Care Quality Commission (CQC) in October 2011. The practice provides dental services to patients in Northampton and the surrounding area. The practice provides wholly private dental treatment. Services provided include general dentistry, dental hygiene and implants.

The practice website said the practice was open: Mondays to Fridays: 9am to 7pm and 9am to 5pm on Saturdays.

Access for urgent treatment outside of opening hours was by ringing the practice telephone number and following the answerphone message.

The practice staffing consists of one dentist and two dental nurses.

We received positive feedback from 11 patients about the services provided. Patients said they were happy with all aspects of the practice. The dentist was approachable and there were no concerns over the treatment provided. Patients also said the dental nurses were friendly and approachable.

Our key findings were:

• The practice had systems and processes to record accidents and significant events.
• All staff had received whistle blowing training and discussions showed staff were aware of these procedures and how to use them.
• Feedback from patients was positive about the dental service they received. Patients said they were treated with dignity and respect.
• Patients said they were involved in making decisions about their treatment, and records in the practice supported this view. Options for treatment were identified, explored and discussed with patients.
• Patients’ confidentiality was maintained.
• The practice did not have systems to check that essential equipment for dealing with medical emergencies was in date and fit for purpose.
• Risks associated with conscious sedation had not been appropriately identified and mitigated.
• There was lack of an effective, clear system in place for patients to provide feedback about the services. In addition there was no system to analyse any service user comments and make improvements as a result.
• The practice followed the relevant guidance from the Department of Health: ‘Health Technical Memorandum 01-05 (HTM 01-05) - Decontamination in primary care dental practices for infection control.
• X-ray equipment had not been maintained in line with published guidance.
• Governance arrangements were in place for the running of the practice; however the practice did not have a structured plan in place to assess various risks arising from undertaking the regulated activities and to effectively audit quality and safety.

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

• Ensure availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Ensure the practice’s protocols for conscious sedation are suitable giving due regard to guidelines published by the Standing Dental Advisory Committee: conscious sedation in the provision of dental care. Report of an expert group on sedation for dentistry. Department of Health 2003.

• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.

• Ensure suitable governance arrangements are in place and an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Ensure records that are necessary to be kept in relation to the management of the regulated activity are maintained securely.

• Ensure audits of various aspects of the service, such as radiography, are undertaken at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

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 staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
• Review the practice’s protocols for conscious sedation, so that they are suitable giving due regard to guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010. Consider installing a hearing loop as a reasonable addition.

• Review its complaints handling procedure so that it makes it clear which other agencies a patient could contact if the complaint was not resolved to the patients satisfaction.

Review the practices’ current Legionella risk assessment and implement 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’

We found that people who used the service gave their consent for their treatment and care. We observed the dentist provide treatment to a person that attended the clinic. We found that they received a detailed explanation about the risks and benefits of their chosen treatment and were asked for their consent to go ahead with the treatment. We also reviewed five treatment files and found that people had been given information about their treatment and had signed a consent form to say that they were happy to proceed.

On the day of the visit we were unable to speak to people using the service about their experiences of using the clinic; but instead reviewed the improvements the provider had made to the policies, procedures, staff training and audit of infection prevention and control. We also looked at the developments the provider had put in place to improve the decontamination room and cleaning equipment.

There were three people using the service during our visit. We spoke with two of them and the person accompanying one of them. One person told us the service was, “Very good. I think the treatment of neurotic people like me – he’s been really brilliant. Not all dentists are like that.” and “He explains absolutely everything. Shows me what he’s going to do: draws things.”

We asked people if they knew how much they would be charged for each appointment. One person told us, “I wouldn’t be here if I couldn’t afford to pay for private dental surgery. I was told the inspection was so much and the x-ray was so much.” They said they had seen the dentist for quick check-ups and not been charged at all. The other person told us, “We never really got what the final amount was until last week – after a few months.” We asked one person if they had seen the information about fees displayed in the waiting room. They said, “I didn’t see the fees. That’s probably new then.” They added that they thought the information should be displayed more prominently.

The people we spoke with told us they felt safe using the service. We saw that there was no information in public areas about safeguarding people from abuse, so people using the service would not be aware of the provider’s safeguarding procedures. We saw that emergency fire procedures were publicly displayed in the entrance to the building, and that fire exits were prominently marked.

We spoke with one person using the service. She was very pleased with the service and described the dentist as a, "Lovely chap.” She told us that she had been thoroughly assessed and that she had been given enough information to make a decision about treatment. She told us that the dentist did not mind repeating information. Before her treatment, she was very anxious, but afterwards, she told us, “He was as gentle as a kitten."

The person we spoke with told us she had not been given information about fees before she received treatment. She was not aware of the procedures if there were a fire in the building.