We carried out an announced follow-up inspection at Wroughton Dental Practice on the 2 June 2017. This followed an announced comprehensive inspection on the 3 March 2017 carried out as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what actions they would take to meet the legal requirements in relation to the breaches.

We revisited Wroughton Dental Practice and checked whether they had followed their action plan.

We reviewed the practice against three of the five questions we ask about services: is the service safe, effective and well-led? 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 Wroughton Dental Practice on our website at www.cqc.org.uk.

Background

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The follow up inspection was led by a CQC inspector who was supported by a specialist dental adviser.

During our inspection visit, we checked that points described in the provider’s action plan had been implemented by looking at a range of documents such as risk assessments, staff files, policies, staff training and availability of equipment.

Our findings were:

• The principal dentist was the safeguarding lead professional and processes were in place for safeguarding adults and children.
• The practice had updated their policies and procedures using a commercially available dental clinical governance system which had been recently introduced by the practice owner.
• The practice had systems to help them manage risk, although some signage needed to be reviewed.
• The practice had staff recruitment procedures and all staff were meeting the requirements of their professional registration.
• There was effective leadership at the practice and systems were in place to share information and learning amongst the team.
• The practice had systems in place to seek feedback from patients.
• The dentist provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• Premises appeared maintained and visibly clean and cleaning equipment seen was in line with current guidelines, although not suitably stored.
• Staff knew how to deal with medical emergencies. Appropriate medicines and most of the life-saving equipment were available. Improvements were still required as there was no Automated External Defibrillator (AED) on the premises, no child face mask for attaching to the self-inflating bag and no recorded log of checks on the emergency drugs and equipment. Although there was a documented operational policy relating to the management of such emergencies the location of the local community AED and who would be responsible for collecting it, was not detailed. There was no documented risk assessment available.
• The practice had infection control procedures which mainly reflected published guidance. There were systems in place to ensure that all equipment used to sterilise instruments was being validated as per national guidelines; and maintained as per manufacturer’s recommendations. Improvements were still required as there was no current legionella risk assessment, carried out by a competent person and the dirty / clean zones and sinks were not labelled correctly.
• There was no annual statement available in relation to infection prevention and control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Dental care products and medicines requiring refrigeration were stored in sealed containers in a domestic fridge. The fridge also contained a small amount of food.

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

• Review availability of equipment such as an Automated External Defibrillator (AED) to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team. The provider must ensure a risk assessment is undertaken if a decision is made to not have an AED on-site.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the use of risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Review the practice’s audit protocols to ensure infection control audits are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.
• Review the need for an annual statement available in relation to infection prevention and control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the storage of dental care products requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

We carried out an announced comprehensive inspection on 3 March 2017 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

Wroughton Dental Practice is a dental practice providing private treatment mainly for adults but does treat the children of registered patients.

The practice is based close to local amenities and car parking in Wroughton. The practice has one reception / waiting room, an open plan office area, two treatment rooms (although one is only used to take x-rays). There is a separate room for the cleaning, sterilising and packing of dental instruments which was also used by staff for making beverages, storing personal items and fridge storage.

Although the practice was on the ground floor, the current entrance was not configured so that it was easily accessible to patients who used a wheelchair.

The practice owner is the principal dentist and employs one trainee dental nurse and a receptionist.The practice opens Wednesday: 09:am to 1pm (only pre-booked patients), Thursday and Friday 9am to 1pm & 2pm to 5pm

There were arrangements in place to ensure patients receive urgent dental assistance when the practice was closed. If patients called the practice when it was closed, an answerphone message gave the telephone number patients should ring and there were notices in the reception area giving the details. Wherever possible, patients who require emergency dental treatment were seen the same day if the practice was open.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

Before the inspection, we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. In addition we spoke with patients on the day of our inspection. We received feedback from 19 patients.

Feedback from patients was positive about the quality of care, the caring nature of all staff and the overall high quality of customer care. They commented staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained to them so they could make an informed decision which gave them confidence in the care provided.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Leadership was provided by the principal dentist.
• There were systems in place to check all equipment had been serviced regularly, including the autoclaves and the X-ray equipment.
• Patients could access treatment and urgent care when required.
• Patients gave us a positive picture of a friendly, caring and professional service.
• The practice dealt with complaints according to their practice protocol.
• The principal dentist was the safeguarding lead professional and processes were in place for safeguarding adults and children but the provider was unable to demonstrate two members of staff had undertaken training in child or adult safeguarding
• There were policies and procedures in place but these had not been reviewed for a significant period of time and did not always reflect current guidance and practice requirements.
• The principal dentist had undertaken training and continual professional development, although arrangements for identifying the ongoing learning and development needs and the on-going assessment and supervision of the trainee dental nurse and receptionist had not been established.
• The dentist provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines, although they did not routinely use a rubber dam for root canal treatments.
• Staff had been trained to handle emergencies and appropriate medicines were in place. Although some life-saving equipment was readily available in accordance with current guidelines, some of the equipment was outside of its expiry date and there was no Automated External Defibrillator (AED) on the premises. There was no documented operational policy relating to the management of such emergencies.
• Premises appeared maintained and visibly clean, although cleaning equipment seen was not in line with current guidelines.
• The infection control policy had not been reviewed and therefore some information, risk assessments and practices were not available or in line with guidance issued by the Department of Health, the 'Health Technical Memorandum 01-05 decontamination in primary care dental practices (HTM01-05). This included a current legionella risk assessment, carried out by a competent person.
• Quality monitoring such as by undertaking regular audit of the infection control process had not been completed and there was no annual statement available in relation to infection prevention and control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Dental care products and medicines requiring refrigeration were stored with food in a domestic fridge. Some products were out of date and the fridge temperature was not regularly monitored or suitably recorded.
• The practice had not carried out pre-employment recruitment checks for one staff member.

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

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking the regulated activities.

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 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 recruitment policy and procedures to ensure character references for new staff as well as proof of identification and other checks are requested and suitably recorded.

• 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 access to interpreter services for consultations with patients whose first language is not English.
• Review the practice of leaving treatment room doors open when patients are receiving or discussing treatment during consultations

We had the opportunity to speak with two patients who told us that they had received information about the service. They said that the dentist always explained their treatment options. There was information about the service, treatment options and costs in the waiting room.

People's care and treatment was planned and delivered in a way that met their needs. People told us that if they needed treatment they had a treatment plan with the costs. They also said that the dentist took a medical history and asked them to update this.

People were treated in an environment which was clean and hygienic. The people we spoke with told us that the surgery was always clean. They also said how safe they felt with the staff.

There was a process to give comments and feedback so people could give their views about the service. There were risk assessments and auditing systems to make sure the service provided was safe.