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02nd December 2011

CQC Inspections – First Inspections

The Care Quality Commission is now finally getting around to inspecting dental providers in England, with some practices reporting a first contact from the regulator in recent weeks. Being prepared for a CQC visit will be a novelty for most Primary Dental Providers, but some learning can be extracted from a recent inspection.

The CQC have just published a damning compliance report regarding Dr Setumo Madiehe’s West Street Practice in Congleton, Cheshire, outlining numerous areas where they have serious concerns about this practice meeting the essential standards of quality and safety. The upshot of which, has led to the practice closing by what is assumed to be a voluntary decision. As reported in the Congleton Chronicle on the 27th October 2011, a sign advising of the practice closure was pinned to the front door along with a letter from Central and Eastern Cheshire PCT stating that their contract had been terminated.

A look through the compliance review report published by the CQC makes for interesting reading, especially for those dental practices that have been advised of imminent inspections. 9 specific outcomes were assessed, with 4 having been previously identified as the subject of concerns. To help put this in context, we’ll summarise a handful of the Outcomes assessed and the findings of the CQC that were reached:

Outcome 1: People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run:

Essentially, people who use services must understand the treatment, care and support made available to them, be able to express their views and take part in the decision making process, whilst having their independence and privacy respected.

The CQC found that in respect of Outcome 1, the provider was indeed compliant with these standards. The only negative comment being published was that of a complaint by a service user that the practice was in need of being decorated.

Outcome 4: People should get safe and appropriate care that meets their needs and supports their rights:

People who use services should “experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights”.  The CQC found major concerns with Outcome 4.

It was noted that the day before the inspection, the local primary care trust had issued a remedial notice to the registered provider because they had found evidence of: “poor record keeping; poor patient examination and lack of coherent treatment planning; lack of pre-operative radiographic assessment; no written assessment of radiographs when taken; over-prescribing of antibiotics” and so on.  Further concerns were raised about the oxygen cylinder and the First Aid kit.

Outcome 7: People should be protected from abuse and staff should respect their human rights.

As stated in the outcome, robust procedures and evidence of them being followed, must be in place to ensure that people who use services are indeed protected from abuse, the risk of abuse and that their human rights are upheld and respected at all time. Moderate concerns were found regarding Outcome 7.

It was found that there was no evidence of any policies or training in relation to safeguarding vulnerable adults having been put in place.  This was therefore identified as being a risk.

Outcome 8: People should be cared for in a clean environment and protected from the risk of infection.

Cleanliness and infection control should be of paramount concern to any provider of a dental service, but in this case, the CQC found major concerns with Outcome 8.

The findings here were quite extensive, but a short summary would include: “Practice not compliant with the essential quality requirements of Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05)”;  A non hands-free tap at the single dedicated hand washing facility – one of the taps was also broke; Concerns raised about PPE and lack of glasses for use by patients in treatments others than with the light cure system for setting fillings, plus that the correct PPE was not being used in either the surgery or decontamination settings; Unsealed sharps box; No aids available for examining instruments to ensure cleanliness; No separate area for storage of sterile instruments; Re-use of certain single use items and so on.

Outcome 10: People should be cared for in safe and accessible surroundings that support their health and welfare:

As stated in the Outcome, safety and suitability of premises must be safe, accessible and promote service-users wellbeing. Moderate concerns were found regarding Outcome 10.

The inspector found the premises to be in poor condition, lack of staff facilities, damp on the walls of the kitchen, inappropriate storage of flammable items etc,

Outcome 11: People should be safe from harm and from unsafe or unsuitable equipment.

Here the safety, availability and suitability of equipment is evaluated to ensure that those people who use services, as well as people who work in or visit the premises, are not at a risk of harm from unsafe or unsuitable equipment. Major concerns were found regarding Outcome 11.

An X-ray machine was deemed old and in poor condition - the electrical wiring was worn inside etc; No amalgam separator was installed in the surgery, therefore contravening health and safety regulations and water byelaws (subsequently reported to the HSE).

Outcome 12: People should be cared for by staff that are properly qualified and able to do their job.

This outcome concerns requirements relating to workers. It is vital that people who use services can expect to be safe and that their needs are met by staff that are properly qualified and physically and mentally able to do the role.  Major concerns were found regarding Outcome 12.

Rather worryingly, the CQC found that there was no evidence of any checks having been carried out on suitability of employment of the four people working at the practice. Aside from possessing their cv and conducting an interview, no checks on identity were completed, no references sought and no criminal records checks completed.

The learning from an inspection such as this is that a registered provider absolutely must ensure that all of the CQC outcomes are being addressed and put into practice.  Much of the above can be remedied by robust policies and procedures, such as those provided by QCS Ltd, whilst implementation and adherence to legal requirements would cover the rest.  It is too easy to assume that everything will be ok, but if you do not scrutinise your practices to ensure that they meet the essential standards, then you can be certain that the CQC will do that for you.  In the case of the West Street Practice, this is a salutary lesson.

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