CQC inspected the practice on 22 June 2016 and asked the provider to make improvements regarding Regulations 12 HSCA (RA) Regulations 2014 Safe care and treatment. Regulation 17 HSCA (RA) Regulations 2014 Good governance and Regulation 19 HSCA (RA) Regulations 2014 Fit and proper person. We took urgent enforcement action and the practice voluntarily closed for seven weeks to allow improvements to be made.

The Dental Surgery is a dental practice providing mostly NHS dental treatment 90%, with private treatment options for patients. The practice is located in the centre of Newhaven.

The practice has two treatment rooms, both of which are on the ground floor.

The practice provides dental services to both adults and children. Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment.

The practice’s opening hours are – Monday, Tuesday, and Thursday 9am to 5pm and Wednesday and Friday 9am to 12pm.

Access for urgent treatment outside of opening hours is facilitated 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 two dentists; two qualified dental nurses, one student nurse, two receptionists, and a practice manager.

Our key findings were:

• The treatment rooms were clean and had defined clean and dirty zones.
• We found that some dental care records were not stored securely.
• 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, storing and sterilising dental instruments.
• There was a system to monitor training, learning and development needs of staff members which would be reviewed at appropriate intervals through the on-going assessment and supervision of all staff employed.
• 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 had undertaken a Legionella risk assessment and implemented 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’
• An infection control audit had been undertaken.
• The practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Audits of various aspects of the service, such as radiography and dental care records had been undertaken to help improve the quality of service.
• Audit protocols have been implemented to document learning points which are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.
• The practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• The practice had arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• We saw that dental care products were stored in line with the manufacturer’s guidance and all were in date.
• We saw that dental care records were not stored securely
• Staff could demonstrate awareness of Gillick competency and were aware of their responsibilities.
• All staff had completed training in the Mental Capacity Act (MCA) 2005 and were aware of their responsibilities under the Act as it relates to their role.

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

• Ensure 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).
• Ensure the storage of records relating to people employed and the management of regulated activities is in accordance with current legislation and guidance.
• Ensure that specific training for IR(ME)R for one member of staff is completed by attendance on an external course.

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 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
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review its responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and carry out a Disability Discrimination Act audit for the premises.

We carried out an unannounced comprehensive inspection after receiving some information of concern on 22 June 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 not providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was not providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was not 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 Dental Surgery is a dental practice providing mostly NHS dental treatment, with private treatment options for patients. The practice is located in premises in Newhaven.

The practice has two treatment rooms, both of which are 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.

The practice’s opening hours are – Monday, Tuesday, and Thursday 9am to 5pm and Wednesday and Friday 9am to 12pm.

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 two dentists; two qualified dental nurses, one student nurse, two receptionists, and a practice manager.

We did not provide CQC comment cards prior to our visit as this visit was unannounced. We 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 visibly dirty and lacked defined clean and dirty zones.
• Records showed there were sufficient numbers of 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 not always maintained and some dental records were not stored securely.

• 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 the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning, storing and sterilising dental instruments.
• The practice had the necessary equipment for staff to deal with medical emergencies, and staff had recently received training on 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 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.

• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
• 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 infection control audits are undertaken at regular intervals and learning points are documented and shared with all relevant staff.
• Ensure the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Ensure 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).
• 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 the practice’s 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.
• Ensure audits of various aspects of the service, such as radiography and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure audit protocols to document learning points are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.
• 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 the storage of records relating to people employed and the management of regulated activities is in accordance with current legislation and guidance.

We found this practice was not providing safe or well led care in accordance with the relevant regulations and identified regulations were not being met. We took urgent enforcement action to suspend the practice for seven weeks to allow improvements to be made.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the storage of dental care products to ensure they are stored in line with the manufacturer’s guidance.
• 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
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.
• 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 the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’
• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review its responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and carry out a Disability Discrimination Act audit for the premises.
• Review the availability of an interpreter service for patients who do not speak English as their first language.

When we previously inspected The Dental Surgery we found that the provider was not meeting all the requirements of the Health and Social Care Act 2008.

During this inspection we spoke with three members of staff, these were the practice manager, the office clerk and a dentist.

The improvements required to comply with the regulations, in relation to safeguarding patients from abuse, requirements relating to staff, and assessing the quality of service were in place and had been made.