We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. St Austell Dental Centre 28 East Hill, St Austell, PL25 4TR Date of Inspection: 21 June 2013 Date of Publication: July 2013 We inspected the following standards in response to concerns that standards weren't being met. This is what we found: Care and welfare of people who use services Cleanliness and infection control Supporting workers Assessing and monitoring the quality of service provision Complaints Inspection Report St Austell Dental Centre July

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activities Whitecross Dental Care Limited Miss Emma Jayne Vick St Austell Dental Centre provides NHS dentistry to over 14,000 patients as well as some private treatments. Dental service Diagnostic and screening procedures Surgical procedures Treatment of disease, disorder or injury Inspection Report St Austell Dental Centre July

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 4 Our judgements for each standard inspected: Care and welfare of people who use services 5 Cleanliness and infection control 7 Supporting workers 9 Assessing and monitoring the quality of service provision 11 Complaints 13 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report St Austell Dental Centre July

4 Summary of this inspection Why we carried out this inspection We carried out this inspection in response to concerns that one or more of the essential standards of quality and safety were not being met. This was an announced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 21 June 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider. What people told us and what we found We spoke with eight patients during our inspection. All of whom commented positively about the treatment they had received, their comments included, "I can only speak very highly of the practice.", "Very good overall." and "They are improving all the time." People experienced care, treatment and support that met their needs and protected their rights. People were protected from the risk of infection because appropriate guidance had been followed. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. The provider had an effective system to regularly assess and monitor the quality of service that people received and there was an effective complaints system available. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report St Austell Dental Centre July

5 Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement We spoke with eight patients who were attending St Austell Dental centre on the day of our inspection. All of the patients we spoke with commented positively about the treatment they had received, their comments included, "I can only speak very highly of the practice.", "Very good overall." and "the dentists are not pushy, they give you the information and time to think about it." We reviewed four patient treatment plans and found they had been completed in legible handwriting using language patients could understand. We found clear and concise details of the findings of examinations and results of treatment had been recorded on each patients records. We observed the treatment of three patients by two different dentists during our inspection. We found there had been a noticeable improvement in interactions between staff and patients. The dentists and dental nurses worked together as a team and actively engaged with patients to put them at their ease. We saw each patient's medical history was checked at the beginning of their appointment. During our observations of treatment we saw examples of how the dental staff clearly explained to patients why treatment was necessary and the use of a mirror, assisted patients to understand the results of their examination. During treatment patients were provided with eye protection and an apron and we observed dental staff wore appropriate personal protective equipment (PPE) and short sleeved tunics while providing treatment. This promoted the control of infection and reduced the risk of cross infection. We saw the practice was following guidance issued by the UK Resuscitation Council in that an Automated External Defibrillator and two bags containing emergency medications were available at the practice. This equipment was maintained by an external contractor. Records demonstrated all medications were in date and emergency medical equipment Inspection Report St Austell Dental Centre July

6 had been appropriately serviced. Training records demonstrated that all staff had completed annual training in Cardio Pulmonary Resuscitation (CPR). This meant that patients were effectively protected against the risks of medical emergencies as the provider had complied with relevant guidance and staff had received appropriate training. We saw X-Ray equipment was available in every surgery. Every dental practice with radiographic (X-Ray) equipment is required to provide a set of "local rules". These record all the working practices dentists must follow to ensure safety when working with radiation. We saw that local rules were in place to ensure the safe operating of the X-Ray equipment and included the contact details of a Radiation Protection Advisor. This means staff had instant access to relevant safety information. Inspection Report St Austell Dental Centre July

7 Cleanliness and infection control People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was meeting this standard. People were protected from the risk of infection because appropriate guidance had been followed. Reasons for our judgement The "Health Technical Memorandum 01-05: Decontamination in primary care dental practices" (HTM01-05) published by the Department of Health sets out in detail the processes and practices essential to prevent the transmission of infections. We found at this inspection that there was sufficient decontamination equipment available for the practice to achieve best practice standards of decontamination. This was not however achieved during our inspection as instruments were ultra-sonically cleaned and then sterilised in accordance with the essential standards of HTM Staff told us the washer disinfector was only used to clean dental instruments at the end of treatment sessions. This practice had developed as the cleaning cycle time of the washer disinfector made it impractical for use during treatment sessions where instruments needed to be rapidly reprocessed. Our inspection of 26 November 2012 found only one of the three autoclaves available in the decontamination room was fully operational. At this inspection we found all three autoclaves were functional and had been regularly serviced. Records demonstrated this equipment had been operating effectively and daily checks had been completed. Other records demonstrated that when the washer disinfector had failed a daily protein test strip the practice had immediately contacted the servicing company and taken action to address the fault. At our pervious inspection we found the decontamination room was uncomfortably hot and humid with the sole source of ventilation a single domestic type extractor fan. At this inspection we noted the extractor fan had been upgraded to an industrial unit and that the water distillation equipment had been removed from the decontamination room. This had lowered the humidity of the room but the temperature remained high. A programme of temperature monitoring of the decontamination room four times per day had been introduced by the provider. Records show that the temperature in the decontamination room was regularly in excess of 38 degrees centigrade when instruments were being reprocessed. We discussed the high temperature issue with the providers multi-site manager, who told Inspection Report St Austell Dental Centre July

8 us the results of the on-going temperature monitoring were currently being analysed. The manager explained that additional ventilation or the installation of an air conditioning system was being investigated. This was confirmed by the minutes of staff meetings where the temperature of the decontamination room and possible solutions to the problem had been discussed with staff. We again toured the practice at this inspection. We saw that no action had yet been taken to address the shabby appearance of the practice. In addition to the damaged paint work and stains previously noted we found the seal between the flooring and walls had failed in a number of treatment rooms making them permeable and difficult to effectively clean. We discussed this with the multi-site manager who explained the practice was due to be refurbished in this financial year but that the actual date of the refurbishment had not yet been confirmed. We requested the manger forward us additional details of the planned refurbishment after the inspection however this information has not yet been received. Our inspection of the 26 November 2013 found treatment rooms were not appropriately cleaned between patients and some clinical staff wore long sleeved personal clothing while treating patients. This did not negate the risk of cross infection. At this inspection we observed that treatment rooms were cleaned effectively using appropriated technics between patients and all clinical staff wore short sleeved clothing. Inspection Report St Austell Dental Centre July

9 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement All eight of the patients we spoke with during our inspection were complimentary about the care they had received from staff St Austell Dental Centre. Comments included, "They put me at ease.", "The dentist is good to us." and "The staff are absolutely superb." We also spoke with five members of staff during our inspection who told us, "I try to do my job the best I can", "things are a lot better" and "the new manager is firmer and gets things done." The practice had a detailed induction policy and all new members of staff completed a workbook to demonstrate they had read and understood the practices policies and procedures. Staff contracts indicated there was a three month probationary period for new members of staff. We saw an induction checklist for agency staff had been introduced to ensure that temporary staff also received appropriate information about the practice and it's policies and procedures. We reviewed the records associated with three members of staff and found them to include contracts of employment, job descriptions, immunisation records, Disclosure and Baring Service checks and training certificates.this means people who use the service were protected from the risks associated with staff who were unsuitable to work with vulnerable people. We found a system to record details of the continuing professional development (CPD) training completed by associated dentists had been introduced since our last inspection. There were also full records of the CPD training completed by registered nursing staff within individual staff files. We saw plans were in place to introduce quarterly one to one supervision meetings between nursing / reception staff and the registered manager. We saw records which demonstrated supervision meetings had been held between the multi-site manager and all associate dentists since our last inspection. Supervision is a vital tool used between an employer and an employee to capture working practices. It is an opportunity to discuss ongoing training and development. Inspection Report St Austell Dental Centre July

10 We were told by the Multi-site manager a new system of annual staff appraisals was to be introduced to the practice. Regular monthly staff meetings were held at the practice and the minutes demonstrated staff were free to raise and discuss possible solutions to any problems that had been identified within the practice. Inspection Report St Austell Dental Centre July

11 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people receive. Reasons for our judgement We spoke with eight patients during our inspection all of whom were satisfied with the treatment they had received. Patients comments included, "They are improving all the time." and "They are very good overall." During our previous inspection of St Austell dental Centre on 26 November 2012 we observed the treatment of two patients by two different dentists and found the dentists' manner was formal and interaction between the dentists and patients was direct and process driven. One patient told us during the previous inspection the dentist had been "blunt" and our review of comments on NHS choices found a number of similar incidents had been reported by patients. Prior to this inspection we again reviewed comments made by patients on the NHS Choices website. In total ten people had commented on this service since our last inspection. Seven of the comments had been positive and included, "you are a fantastic dentist" and "Have been at this practice since Feb and found the dentist and staff very polite." However three negative comments had also been received which generally referred to difficulties contacting the practice by telephone. These issues are addressed in detail below. At this inspection we observed the treatment provided to three patients by two of the dental teams working at St Austell Dental Centre. We found there had been an improvement in the interactions between the dentists and dental nurses who we observed working together as a team. The dental teams effectively engaged with the patients and endeavoured to put them at ease prior to treatment. We observed dentists clearly explaining the findings of examinations and available treatment options with patients. We found since our last inspection the registered manager had returned to work on a part time basis and a multi-site manager had been appointed to provide additional management support to the practice two days per week. Inspection Report St Austell Dental Centre July

12 We spoke with five staff during our latest inspection and were told, "Management has improved", "Things are a bit more organised" and "It's been a change for the better." The new management team had taken action to address some of issues identified in the previous report and new systems for monitoring and recording accidents and complaints had been instigated. At the pervious inspection there had been some confusion as to how associated dentists working at the practice were managed. At this inspection we found the new multi-site manager had instigated direct, one to one supervision meetings with each associate dentist and issues in relation to the management of associate dentists had been clarified. The multi-site manager also explained that the provider's Clinical Director had visited the practice to address issues raised in the previous report with staff. When we telephoned the practice to announce our inspection on the 26 November 2012 it was necessary to call the practice six times before the telephone was answered. At this inspection we again attempted to call the practice six times to announce our inspection but we were unable to get through to reception staff. One of the patients we spoke to during our inspection told us, "It's horrendous, you can never get through." Two of the negative comments reported on NHS choices since our last inspection made reference to difficulties contacting the practice by telephone. We discussed this issue with the multi-site manager during the inspection who explained that they had recruited an additional member of reception staff earlier in the week of the inspection. Reception staff told us there seemed to be a fault with the system as the phone did not always ring when calls were made to the practice. The manager explained the fault would be investigated and the provider was currently trialling a new call handling system at other locations. If successful the new system would be adopted by St Austell Dental Centre. Inspection Report St Austell Dental Centre July

13 Complaints People should have their complaints listened to and acted on properly Our judgement The provider was meeting this standard. There was an effective complaints system available. Reasons for our judgement Our previous inspection on 26 November 2012 found complaints had not been appropriately investigated in line with St Austell dental Centres complaints policy. At our inspection on the 21 June 2013 we found new procedures had been introduced to monitor and manage complaints received by the practice. Complaints received since our last inspection had been logged into the complaints folder. The complaints had been responded to appropriately within the time limits set down in the complaints policy. We noted that two complaints had been investigated and resolved on the day they were raised with the practice. Prior to our inspection we reviewed comments left by patients on the NHS Choices website. Only three of the ten people who had commented on the website since the last inspection had made negative comments. We found that the registered manager had responded to all comments. Where patients had expressed disappointment with the standards of treatment supplied by St Austell dental Centre the registered manager had requested the patients contacted the practice directly so their complaint could be fully investigated. We found that one individual who had commented negatively had contacted the practice as requested. This individual had subsequently reported that they had been satisfied with the results of the investigation into their complaint. We saw evidence that all practice staff had attended specific training on the provider's complaints handling toolkit and associated processes in April Inspection Report St Austell Dental Centre July

14 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report St Austell Dental Centre July

15 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report St Austell Dental Centre July

16 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report St Austell Dental Centre July

17 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report St Austell Dental Centre July

18 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report St Austell Dental Centre July

19 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Inspection Report St Austell Dental Centre July