Banbury town centre dental practice is told to make improvements after inspection

Mydentist in Cornhill, Banbury is part of a dental group with multiple practices providing NHS and private care for adults and children.

A CQC inspector and specialist dental adviser visited on January 13.

They said the practice was visibly clean but its infection control procedures were not effective.

"We were told infection control audits had not been carried out at appropriate intervals between July 2021 and January 2023.

“The practice had policies and procedures in place to ensure clinical waste was segregated and stored appropriately in line with guidance (but) the practice did not have adequate procedures to reduce the risk of Legionella or other bacteria developing in water systems,” they said.

“Evidence of legionella water temperature and bacteria tests, in line with risk assessment actions required, was not available from July 2022 - January 2023.

“The provider confirmed tests had not been carried out but restarted as a result of our inspection announcement.”

There was not an effective cleaning process in place. In particular cleaning standards checks were not carried out and storage arrangements for cleaning equipment did not follow national guidance.

Recruitment checks had not been carried out in accordance with relevant legislation.

The inspection team looked at four staff recruitment records. Evidence presented confirmed:

• None out of four had evidence of conduct in their previous employment (references)

• Two out of four had evidence of a full employment history

• Three out of four had a medical history

• One out of four had a disclosure and barring (DBS) check

• Two out of four had immunity to Hepatitis B

• Two out of four received a structured induction.

Clinical staff were qualified, registered with the General Dental Council and had professional indemnity cover.

The practice had arrangements to ensure the safety of the X-ray equipment and the required radiation protection information was available.

“We were shown an antimicrobial prescribing audit which was carried out the week prior to our visit. The sample size of records audited was not adequate. There was no evidence of the results of the audit and any resulting action plan and a previous audit was not available.” the report said.

"The provider had systems in place for reviewing and investigating incidents and accidents. The practice did not adopt these.

"The practice did not follow the systems in place to ensure dental professionals were up to date with current evidence-based practice. In particular reporting of x-ray quality changed to a new two-point grading of ‘acceptable or unacceptable’ in 2021. This system was not being used by any of the clinicians taking radiographs.

“We were shown a radiography audit which was carried out the week prior to our visit. The record sample size did not meet current requirements. There was no evidence of the results of the audit and any resulting action plan. A previous audit was not available.”

Staff knew how to deal with medical emergencies, safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.

Clinicians provided patients’ care and treatment in line with current guidelines. Staff provided preventive care and supported patients to ensure better oral health.

However staff training was not monitored effectively. The practice did not have appropriate quality assurance processes to encourage learning and continuous improvement.

Evidence was not available to demonstrate all staff had the skills, knowledge and experience to carry out their roles.

Training was not kept in an ordered way or monitored to ensure relevant staff had carried out training at required intervals.

In the previous year, five out of seven staff carried out Basic Life Support training, three of seven carried out fire safety training, three of seven carried out infection prevention and control training, three of seven staff carried out the appropriate level of safeguarding children training and five of seven carried out the appropriate level of safeguarding vulnerable adults training.

None of the seven staff carried out learning disability and autism training. Evidence to confirm that staff appraisals were carried out was not available

The provider did not ensure facilities and equipment were safe and that equipment was maintained according to manufacturers’ instructions. Annual fire risk assessment reviews were not carried out. Fire alarm tests were not carried out appropriately and an external wooden fire exit door had swollen in size and was hard to open.

Emergency lights annual servicing records were not available. A 2019 fire risk assessment action plan was not completed and the electricity supply cupboard to the first floor was unlocked.

Records of monthly emergency light tests, carried out since February 2019, did not indicate that 21 emergency lights did not work. This was identified at every annual service carried out during this period, but actions were not taken to remedy this. Action had been taken to rectify this prior to the CQC visit.

A fire exit door was blocked by a ‘do not use’ sign and hazard warning tape. A second exit was blocked by rubbish bags and clothing debris. Action was taken on the day of our visit to rectify these shortfalls.

Staff worked together and with other health and social care professionals to deliver effective care and treatment. The dentists confirmed they referred patients to a range of specialists in primary and secondary care for treatment the practice did not provide but these were not centrally monitored to ensure they were received in a timely manner.

The report said the practice must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, ensure those employed in the provision of the regulated activity receive the appropriate training to enable them to carry out the duties and ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed and specified information is available regarding each person employed.