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Kensington Park Dental Clinic by mercy2beans126

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									            HEALTHCARE INSPECTORATE WALES


                              Care Standards Act 2000




                              INSPECTION REPORT
                         Private and Voluntary Healthcare
                        Kensington Park Dental Clinic




                                 Date of Inspections
                              th
                             5 July & 7th September 2007




You may reproduce this Report in its entirety. You may not reproduce it in part or in
    any abridged form and may only quote from it with the consent in writing of
                         Healthcare Inspectorate Wales.
                                         Regulation Team
                                     Healthcare Inspectorate Wales
                                             Bevan House
                                       Caerphilly Business Park
                                         Van Road, Caerphilly,
                                              CF83 3ED

                                      INSPECTION REPORT

 Inspection Episode:                  April 2007 to March 2008

 Healthcare Provision:                        Kensington Court Dental Clinic
                                              Newport, S Wales
 Contact telephone number:                    01633 279992

 Registered Provider:

 Responsible Individual:                      Mr. Mark Robotham

 Registered Manager:                          Ms Heather O'Connell

 Number of places:                            None

 Category:                                    Independent Hospital

 Date of first registration:                  11th June 2003

 Date of publication of this report:          15th November 2007

 Date of previous published report: 14th March 2007

 Lead Inspector:                              P Price

 Specialist Inspectors/Advisors:              Mrs J Davies Children’s Service Adviser
                                              Mr. A Doherty Paediatric Dental Surgeon




PP/SF/Kensington Court Dental Clinic- 0708/                                             2
                                 GUIDELINES ON INSPECTION

INTRODUCTION

This report has been compiled following an inspection of the hospital undertaken by the
Healthcare Inspectorate Wales (HIW) under the provisions of the Care Standards Act 2000
and associated Regulations.

The report contains information on the process of inspection and records its outcomes.
The report is divided into nine distinct parts reflecting the broad areas of the National
Minimum Standards. An overall conclusion of the hospital’s compliance with Private and
Voluntary Healthcare (Wales) Regulations 2002 is recorded.

The HIW’s Inspectors are authorised to enter and inspect healthcare establishments at
any time. At each inspection episode or period there are visit/s to the service in addition to
a range of other activities, self- assessment and the use of questionnaires. HIW try to find
the best way of capturing the experiences of patients, their relative/representatives and
staff employed within the service.

At any other time throughout the year visits may also be made to the service to investigate
complaints and in response to changes in the setting. Inspection enables the HIW to
satisfy itself that continued registration is justified. It ensures compliance with:

•   Care Standards Act 2000 and associated Regulations whilst taking into account the
    National Minimum Standards

•   The setting’s own statement of purpose

Readers must be aware that the report is intended to reflect the findings of the Inspector at
the particular inspection episode and should not conclude that the circumstances of the
service will be the same at all times. The National Minimum Standards are also very
detailed and some are technical in nature and the HIW does not look in depth at all
aspects of these standards on each visit.

The report clearly indicates the requirements that have been made by HIW. This includes
those made by HIW since the last inspection report which have now been met,
requirements which remain outstanding and any new requirements from this recent
inspection.

The reader should note that requirements made in last year’s report which are not listed as
outstanding have been appropriately complied with.

If you have concerns about anything arising from the Inspector's findings, you may wish to
discuss these with the HIW or with the registered person.

The Healthcare Inspectorate Wales is required to make reports on registered facilities
available to the public. The report is a public document and will be available on the
Healthcare Inspectorate Wales web site: http://www.hiw.org.uk/




PP/SF/Kensington Court Dental Clinic- 0708/                                                 3
OVERALL VIEW OF THE HEALTHCARE SETTING
The clinic is situated in premises in Chepstow Road in Newport, South Wales. There is
limited parking at the front and back of the building. The clinic is well sign posted and
relatively easy to find.

The Clinic provides private dental services, including services for General Anaesthetic/
Conscious Sedation assessment services and a General Anaesthetic service for the
treatment of dental pain and anxiety management in children aged up to 17 years. This
process is through a referral system only and ensures that a fully integrated service both at
professional and clinical level, complimentary to the local General Dental, Community
Dental and Hospital Dental Services.

Children with dental pain and dental anxiety issues, who are unable to receive dental care
and treatment under local anaesthesia, are assessed for the suitability of General
Anaesthetic and Conscious Sedation. The services of General Anaesthesia, Conscious
Sedation and Anxiety Management are then provided, as appropriate, following the Child’s
assessment.

The Clinic has a Clinical Governance Strategy; audit is undertaken and relevant policies
and procedures which reflect best practice and the dental National Service Frameworks
are in place. There are excellent standards of care and a bright, child friendly environment.
The facilities, information and equipment are appropriate to the care of children.

The Clinic has sound recruitment procedures and prides itself in delivering a high quality
service.

The Inspection team noted a number of good practice commendations in different
areas/services of the hospital.

The inspection team would like to thank the staff team for their time, assistance and co-
operation during the inspection.


METHODOLOGIES USED IN THIS INSPECTION
• Two unannounced visits.
• Discussion with the Management team.
• Examination of records maintained within the hospital.
• Discussion with staff.
• Visual inspection of the building and its facilities.
• Follow up discussion with the management team




PP/SF/Kensington Court Dental Clinic- 0708/                                                4
                                   INFORMATION PROVISION

Inspector’s findings:
Statement of Purpose & Patient Guide
The statement of purpose and patients guide is comprehensive and concise. It includes
the aims and objectives of the clinic. The statement of purpose was seen to provide all
the information required by regulations.

Additional Information
Clear patient information is available and the contact numbers for translators and
translation into foreign languages if required is available. The Clinic is working towards
providing a more comprehensive range of age appropriate literature for Children. Staff
provide clear, child friendly pictorial and verbal explanations to the Children and their
Families in a way that fully takes their age and understanding into consideration.

For those whose first language is not English, the clinic employs Welsh speakers and
utilises the services of Language Line as required.

Information leaflets on dental health promotion are available at the clinic. This is noted
and commended.

Information of the contact information of Children’s Helplines and Advocacy Agencies is
clearly displayed and is good practice.

Patient Questionnaires
Satisfaction questionnaires are used to obtain patient/relatives views on care provision.
Children satisfaction questionnaires are available and their use is encouraged and
promoted. The results of these are available to the public. The outcome of these
demonstrates a very high level of satisfaction with the service received.

Advertising
Advertising complies with the General Dental Council (GDC) Standards for Dental
Professionals and the ethical framework set out in the GDC document “Maintaining
Standards”.


New requirements from this inspection:
         Action Required               Timescale for                 Regulation Number
                                        completion
Continue to develop age appropriate November 2007                   Regulation 35 (d)
information



Good practice Recommendations:
Continue to promote the children’s’ completion of questionnaires.




PP/SF/Kensington Court Dental Clinic- 0708/                                              5
                             QUALITY OF TREAMENT AND CARE

Inspector’s findings:
Care Pathways
The Kensington Court Clinic has Care pathways in use for anaesthetic care and nurse
assessment. There are specific policies in place to ensure care is provided in a person-
centred way. There are copies of treatment protocols and policy and procedures. The
National Institute for Health and Clinical Excellence (NICE) guidelines are followed.
Particular measures have been taken to provide a child-friendly environment.

The procedure in which the child service user is met by the Registered Sick Child Nurse
(RSCN), who then accompanies the child through the care pathway is a clear example
of best practice. This is noted and commended. The clinic staff will meet gender
preference of service users. This is noted and commended.

A care pathway record and history was used with parents and patient, the nature of
treatment proposed at the preceding assessment was ascertained with the consenting
parent.

The patient journey is graphically illustrated in the waiting and assessment areas with
‘Winnie the Pooh’ at various stages in the treatment process. The patient engaged
directly with this concept and was led through the stages most effectively by the
paediatric nurse.

One patient elected to communicate only in Welsh – the paediatric nurse is a Welsh
speaker and facilitated communication at all stages. This is to be commended.

An explanation, in patient/situation appropriate language, of each stage was given and
questions invited from the patient. Both patient and parents were involved in this
interchange.

The above assessment is undertaken in an area currently set-aside during the General
Anaesthetic session. This area contains an OPT x-ray machine and has a sloping floor.
The clinic is physically limited in the space available but consideration should be made
of the suitable and practicable provision of an alternative to the current assessment
area.

The Operating Room Stage
Where the patient was able to co-operate, a pre-operative examination was undertaken
with the parent/consent giver shown the treatment proposal. The majority of patients
had been assessed previously and alterations to treatment plans occurred pre-
operatively with clear consent from the parent giving consent.

While consent was obtained from the parent, where appropriate to the individual child,
the treatment was clarified with the child also.

Referral is made on a standard proforma. Changes are made to treatment plans from
referring dentists on a regular basis. A policy exists to allow for communicating and
facilitating treatment plan alterations. It was noted that variation exists between referral
prescription and treatment provided. Treatment plans are changed from referral to
treatment according to clinical need. Occasionally treatment plans are altered mid
treatment. A policy on subsequent actions exists. The application of the policy should be
PP/SF/Kensington Court Dental Clinic- 0708/                                                    6
compared to actual clinical situations.
Therefore an audit of the variance between referral prescription and actual treatment
prescribed/provided is recommended. This will allow identification of rate of variance
and further audit will identify referral patterns, anecdotally available but not currently
quantifiable. An audit of this type will, by its nature, be of subjective data. It will also
identify where training needs of referring practitioners arise.

Anaesthetic consent was achieved with clear post- operative instruction.

Pre and Post-operative instructions are given by the referring dentist. Post-operative
instructions are given in written and verbal formats at the treatment appointment. An
information sheet on preventing dental disease is available. An Out of Hours
(07000)phone number is available to patients after treatment.

Following recovery, the patient continued to ‘second recovery’ to prepare for discharge,
accompanied by their responsible adult/parent.

All patients booked on the session were aged under 17 years. All patients were
accompanied into the operating room by the Paediatric Nurse. Treatment provision was
uneventful. The nurse, to whom they had been introduced prior to the provision of
anaesthesia recovered each patient. However, it was noted that entries in records are to
be identified to the person inserting the entry. Entries must be signed, legibly.

One teenage patient was particularly anxious about treatment. An extended time was
allocated to discuss with him the issues and options in his care. There had been a long
history of treatment requiring GA and restorative care using GA had been proposed.
The patient declined the procedure but agreed to acclimatisation and expressed his
intention to return and have treatment at a subsequent appointment. Although time was
spent clarifying the plan and explaining the issues to this patient, no coercion was
applied and the patient’s anxiety appeared to be reduced.

Staff Training
As part of the induction process all staff are given adequate time, away from working
duties, to read these policies and procedures and sign that they have done so. All staff
are encouraged to regularly review their knowledge on these matters and to familiarise
themselves on recent updates/changes to policies and procedures.
A staff signature database is available.

Quality Audit
The preceding visit report recommended the provision of an audit of variation between
referral prescription and treatment provided. This has not yet been carried out; the audit
lead indicated in his annual report that this would be considered as the next audit topic.

An audit of the repeat referral of patients subsequent to an initial course of treatment will
allow further patterns to be identified. The expressed hope of the clinical team is that
each course of care would be sufficient to achieve oral health for the patient, allowing
the referring General Dental Practitioner (GDP) to secure further care without the use of
General Anaesthesia.

Policies & Procedures
Kensington Court Clinic operational policies and procedures are reviewed annually. The
manager has a central sheet, recording the review dates of policies.

PP/SF/Kensington Court Dental Clinic- 0708/                                                     7
There are written policies and procedures for clinical outcomes and performance
indicators. Policy available on alteration of treatment plans. Review should be evidenced
of how policy reflects local practice. Procedures are in place on handling information
and record systems. There is a near miss and adverse incident reporting mechanism
and also a complaint procedure. There is a nominated person responsible for reviewing
the critical incidence files. A comprehensive, written policy is in place to deal with the
event of a sudden death at the clinic.

Kensington Court Clinic has an extensive library of policies and procedures governing
quality of treatment and services. A comprehensive range of policies and procedure was
seen to be available to guide staff. As part of the induction process all staff are given
adequate time, away from working duties, to read these policies and procedures and
sign that they have done so. All staff are encouraged to regularly review their knowledge
on these matters and to familiarise themselves on recent updates/changes to policies
and procedures.


Good practice Recommendations:
Audit of referral prescription and treatment outcome recommended.
Signature database has been instigated and should be maintained.
Review should be evidenced of how policy reflects local practice.




PP/SF/Kensington Court Dental Clinic- 0708/                                                  8
                               MANAGEMENT AND PERSONNEL

Inspector’s findings:
Registered Manager
The registered manager has the appropriate experience and qualifications. These include
a relevant manager qualification and the professional Diploma in Dental Practice
Management.

Human Resources
Human Resource policies reflect current employment legislation. CRB checks, verification
of professional fitness to practice and recent references were evident in personnel
records.

Induction/training, continuing professional development and performance management
was also demonstrated. Staff supervision and appraisal is ongoing and formalised.
However, it was noted, that there is no formal mechanism for dental practitioner
supervision. This was discussed with the manager on the day of the visit.

Nursing Staff
Children’s nursing care is led by the Registered Children’s Nurse and there are both links
and shared good and best practice with colleagues in other Children’s dental clinics.
There is evidence of on going training across the disciplines with training plans that
include dental radiography and the use of sedation for dental procedures. There is a clear
commitment to training and professional development and registration within the clinic.
Dental Nurses are required to move from voluntary register to GDC registration by July
2008.

Medical Practitioners/ Consultants
 Medically qualified personnel comply with General Medical Council and relevant Royal
College codes of practice and are subject to professional review within their roles in
secondary care service provision.

All dental staff comply with the General Dental Council standards for dental professionals.
The clinic holds details of continuous professional development and evidence of
revalidation for all senior professional staff.

Operating surgeons and anaesthetists have a letter stating their practising privileges and
responsibilities. The practice has a procedure for recording all practitioners’ registration,
Defence Indemnity Organisation details. The clinic must maintain a contemporary record.
No evidence of false claims evidenced. Practising privileges letters exist. Little variance
from previous years – low staff turnover. Training programme evidenced.

Staff Occupational Health
 A specialist firm is employed to carry out checks with regard to medical questionnaires.
All Kensington Court staff follow Department of Health guidelines governing management
of blood borne viruses. All involved in clinical procedures are vaccinated against Hepatitis
B and records are kept on sero-conversion levels. Procedures accord with the British
Dental Association Advice Sheet A12.

Child Protection
There is evidence of Child Protection training and links with local agencies. This training
is an ongoing programme. CRB checks are maintained and updated.

PP/SF/Kensington Court Dental Clinic- 0708/                                                 9
Adult Protection
 Kensington Court Clinic has a Protection of Vulnerable Adults policy to ensure all staff is
aware of appropriate procedures for protecting vulnerable adults. Training is ongoing.


New requirements from this inspection:
         Action Required                     Timescale for          Regulation Number
                                              completion
Paediatric       nurse        development November 2007            Regulation 17(2)(a)
supervision.

Dental practitioner supervision to be November 2007                Regulation 17(2)(a)
formalised and evidenced.


Good practice Recommendations:
Recommend the practice supports and facilitates the transfer / registration of Dental
Nurses must move from voluntary register to GDC registration by July 2008.
The clinic must maintain a contemporary record.




PP/SF/Kensington Court Dental Clinic- 0708/                                               10
                                 COMPLAINTS MANAGEMENT

Inspector’s findings:
The patient’s guide gives comprehensive relevant information in respect of the complaints
procedure at the clinic. The manager takes a lead role in dealing with complaints and
demonstrated an awareness of the need to support patients and family members with the
complaint’s procedure. An audit trail of complaints was evidenced. A register of
complaints was viewed. The complaint procedure is displayed in the patients waiting
area.

Monthly staff meetings are held at the clinic and are open to all members of staff. Minutes
of the meetings were available for inspection. From observation and discussion with staff
it is evident that the clinic is managed with an open and positive approach, with clear
direction and lines of accountability. All staff expressed their enthusiasm and commitment
to the clinic and complimented the management team on their inclusive and
approachable manner.

Whistle-blowing
The clinic has policies and procedures for 'Whistle-blowing' and staff are aware of whom
to contact should they have any concerns in respect of the clinical performance of a staff
member. This includes the relevant professional bodies.


Good practice Recommendations:
Provide additional Health Promotion material and details of Help/Care/Crisis and
Advocacy agencies such as Childline and the Children’s Commissioner in the waiting
areas.




PP/SF/Kensington Court Dental Clinic- 0708/                                              11
                          PREMISES, FACILITES AND EQUIPMENT

Inspector’s findings:
Premises
All of the facilities and services aspects of the clinic accommodation are situated on the
lower ground floor of the premises.

The premises were maintained to a good standard, with the waiting area sub-divided into
two areas, one primarily for children, which was under the direct supervision of the
reception area. Separate staff changing and rest areas were located off the main
reception area, and these were accessed by digital lock arrangements. Work is ongoing
in the x-ray room and an extractor has now been fitted. Further redecoration has been
agreed and is planned.

The main theatre and recovery areas were well maintained, and refreshment facilities are
available in the recovery area. Separate male and female toilets were available for public
use, and the hot water outlets were controlled with thermostatic controlled valves for
safety.

It was noted that the back corridor fire exit required work, with regard to the stairs and
handrail. The strength/range of lighting in exit corridor also needs to be verified.

Certificates/Testing
The fire alarm, emergency lighting and portable fire-fighting equipment were regularly
inspected and/or tested in-house, with contractors inspecting the installations at the
appropriate intervals. The electrical wiring installation and portable appliance testing
records were all up to date.

A stand-by generator was available in the event of an electricity supply failure, and this
was regular run-up each month and appropriately serviced. The switchover controls were
located in the basement, and a torch was available to access in an emergency.
Commissioning, servicing and maintenance records were available and complete. A
contract was in place for clinical waste storage, and waste awaiting collection was
suitably stored.

Access/Facilities
Access to the facility is by ramp. All doors and through ways appear to be of sufficient
size to allow the passage of a wheelchair or trolley.


Requirements made since the last inspection report which have been met:
            Action Required                 When Completed  Regulation Number
Provide a boiler terminal shield in        January 2007    Regulation 24(2)
accordance with gas safety inspection
report
Install thermostatic control valves to hot January 2007    Regulation 24(2)
water outlets in patient accessible
areas.




PP/SF/Kensington Court Dental Clinic- 0708/                                             12
New requirements from this inspection:
         Action Required            Timescale for      Regulation Number
                                     completion
Stairs to be made safe, handrail One Week             Regulation 24(2)(d)
marked.                          (completed Sep 07)


Good practice Recommendations:
Fire exit lighting strength/range to be verified.




PP/SF/Kensington Court Dental Clinic- 0708/                                 13
                                    RISK MANAGEMENT

Inspector’s findings:
Risk Management
Kensington Court Clinic has a comprehensive Risk Management policy covering all
aspects of the facility and the services it provides. The clinic complies with the British
Dental Association (BDA) (A12) National Guidelines. The risk management policy is
compiled following BDA guidelines. All potential risks/untoward events/near misses etc
are recorded assessed and remedial action recorded as part of on-going management
arrangements. Again, any issue that is likely to impact on service user or staff safety is
notified to appropriate bodies to inform Medical Device Agency information and/or Health
Service Alerts.

It is noted and commended, the Directors of Kensington Court Clinic have established an
exemplary culture, with an organisation committed to seeking constant improvement in all
aspects of its work.

Health and Safety
The importance of children, families and staff Health and Safety is taken very seriously by
the Clinic with its Clinical Governance and Policies and Procedures reflecting this. The
environment in the clinic was appropriate for children and risks to children and families
are assessed and action taken to minimise risks.

The Health and Safety issues identified on the day of inspection related to the main
access door, situated beyond the gated entry porch. It presents a Health and Safety
problem because of its construction. The door has no handle or lock to make it secure
and its hinges allow it to ‘swing’ with force both into and out of the waiting area corridor.
Children, if not adequately supervised, therefore have easy and unrestricted access to
the outside and the car parking area. The door is also at a right angle directly adjacent to
the male toilet and a person going into or coming out of the male toilet could be hit and
injured by this door opening.

There is an uncovered radiator, which is kept switched off, in the waiting area by the
reception desk. During colder months this radiator will need to be functioning to provide
warmth and comfort for all in the Clinic. A recommendation was made to provide a
radiator cover.

There is a designated Health and Safety officer and evidence of risk assessments. All
staff cover health and safety issues during their induction period. The registered manager
deals with MDA alerts.

Staff Fire Training
Staff fire training was undertaken in October 2007. However, it was noted that dental
practitioners had not participated in fire training and/or fire drills. This was discussed with
the manager on the day of the visit.

Infection Control
Infection control policies and procedures were available. Improvements have been made
including a decontamination facility. Ensure validation of steriliser and training from
Manufacturer and keep records for assessment.

The clinic has an extensive staff induction and training programme covering all aspects of
infection control. Appropriate policies and procedures are in place to ensure the risk of
PP/SF/Kensington Court Dental Clinic- 0708/                                              14
patients and staff acquiring an infection, are minimised. Particular attention is placed on
hand hygiene as part of comprehensive staff training in infection control measures.
Children’s toys are cleaned in accordance with Infection Control Policies. All equipment
manufactured for single use is only used once and then discarded appropriately i.e. the
sheathed needles, scalpel blades, LA cartridges, burs are disposed of in the standard
sharps container. Single use instrumentation in sealed disposable packs is used. A policy
for storage of sterile medical devices was evidenced. An inventory of medical equipment
was in evidence.

Medication
The responsibility for the medicine management rests with the senior partner who is a
registered doctor and anaesthetist. The procedures for supply of medicines are
documented. The policies, procedures and practice seen reflects safe responsibility.

Safe Policies and Procedures for the handling and management of medicines are in
place.

A Policy and Procedure for the safe management of medicines and medication
administration is in place for children, resuscitation and emergency drugs are available.
The appropriate ‘double checking’ system was seen on the Day of Inspection.

Radiographs
Justification and prescription of preoperative radiographs is now recorded in patient’s
notes. Outcome from radiographs should be recorded in the patient record.

The notes should contain a record of the operator exposing the patient to x-rays if this is
not the prescribing practitioner.

Decontamination
Where appropriate, single use items are utilised and disposed of. All disposable items are
single use only. Reprocessing of dental equipment including forceps is carried out in the
decontamination area adjacent to the operating room. Prior to sterilisation in non- vacuum
bench top autoclaves, instruments are manually or ultrasonically cleaned and examined
prior to sterilisation. No washer disinfector is available. The autoclaves now have a log
book and are daily tested with a record of cycle outcome. Daily tests of autoclaves are
carried out according to the manufacturer’s instructions (MDA DB 2002(06) and HTM
2010).

 Patient Identification
All patients wear wristbands with their name, height and weight. For patients with
previous medical issues noted, a red band is worn; a green band issued where no
relevant history is noted. This method has been introduced as a result of reflective
practice relating to the patient transferred to UHW from Victoria Park.

Reusable medical devices/surgical instruments
All reusable items are processed manually and autoclaved. Autoclaves are serviced
regularly by the manufacturer.

Resuscitation
All staff have either Advanced Paediatric (APLS) or Paediatric Life Support Skills (PLS)
and qualifications. Current ALS algorithms are on display in surgery and recovery areas.
 Records are available of the training provided to the staff and operators. Each session
should have sufficient appropriately resuscitation trained staff. A record should be made
PP/SF/Kensington Court Dental Clinic- 0708/                                              15
of the presence of appropriately trained staff on the roster present at each session.

Resuscitation Practice
The formal recording of resuscitation drills has begun. Record available of emergency
simulation exercise. This is required by WHC (2001) 056 and records must be available
for inspection as required. Evidence must be held of this process being carried out at
least every two months.

Resuscitation Equipment
A relevant policy and procedure is in place, with appropriate equipment and resuscitation
drugs available. The resuscitation trolley checked as part of the recovery daily setup
There is a policy to transfer patients to the nearest facility if required.

Contracts
Quality assurance protocols are in place. Contracts with Dental suppliers were evidenced
during inspection. Contracts for clinical materials and equipment were evidenced.


Requirements made since the last inspection report which have been met:
          Action Required              When Completed       Regulation Number
There is no definitive record kept of October 2006         Regulation 14(5)
drugs ordered.

 All pre-drawn syringes used in theatre October 2006               Regulation 14(5)
must be labelled when the drug is
drawn up.

Mixer     taps  or    thermostatically November 2006               Regulation 8(1)(4)
controlled hot water is available at
designated hand-wash facilities in one
area.


New requirements from this inspection:
         Action Required                Timescale for                Regulation Number
                                         completion
Adjust the Main Access Door to be September 2007                   Regulation 24(2) (d)
secure and to open one way only.
Provide Hazard Warning sign by the
Male Toilet regarding the danger of the
adjacent door opening.

Provide a radiator cover in the waiting       September 2007       Regulation 24(2) (d)
area by the reception desk.

All teams should have evidence of two         October 2007         Regulation 34(1)
(2) monthly resuscitation drills.

Dental practitioners must participate in      October 2007         Regulation 24(4)(c )(d)
fire training and fire drills. This must be
recorded.


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Good practice Recommendations:
Access agreed training (EPALS) and updates.
A record should be made of the presence of appropriately trained staff on the roster
present at each session.
Must have evidence of two monthly drills.




PP/SF/Kensington Court Dental Clinic- 0708/                                       17
                       RECORDS AND INFORMATION MANAGEMENT

Inspector’s findings:
Patient referrals
Records of the previous day’s operating list were reviewed and the following noted:
• 12 patient records reviewed.
• Age range 3 – 16 years

5 treatment plans altered from referral to treatment provision (all alterations consented.
Anecdotal evidence suggests that the referral pattern from local practitioners leads to
repeat General Anaesthetics through the child patient’s early dental care. Clinic records
should allow an administrative audit of patterns of referral and repeat GA provision for
patients (an electronic patient database is in existence).

Health Records
Kensington Court Clinic has a policy governing requirements for the completion of health
records. A random selection of records confirms that health records are dated, timed,
signed and include all detailed information on both the dental and anaesthetic
interventions. All such records are subject to regular audit as part of quality assurance
processes for record management in general. Care pathways are in use for anaesthetic
care and nurse assessment.

Incident
An incident occurred during May 2007. The incident reporting form used for the incident is
provided by the Royal College of Anaesthetists and the records demonstrate each stage
of the occurrence. The practice ‘loose tooth’ policy (modified) was observed and a review
date has been set for the policy although an issue date was not noted.

Health Records
Records are created, maintained and stored to standards, which meet legal and
regulatory compliance and professional recommendations.

There is a policy for records management and storage, which complies with data
protection regulations. Computer files are backed up and stored. All records are located
in a secure environment.

Confidentiality
Kensington Court Clinic has written policies and procedures to ensure service user
confidentiality. These policies accord with the General Dentist Council Principles of
Patient Confidentiality and meet Caldicott requirements. Staff are aware of their
responsibilities under the Data Protection Act 1998.


                                              RESEARCH

Inspector’s findings:
Research is not undertaken at this establishment.




PP/SF/Kensington Court Dental Clinic- 0708/                                             18
                                     CHILDRENS SERVICES

Meeting the Psychological and Social Needs of Children
Inspector’s findings:
The needs of children and their families are appropriately met by the Clinic. There are
friendly staff and a bright welcoming atmosphere. There are age appropriate toys games,
activities and furniture. Special expertise is demonstrated by the Registered Children’s
Nurse during the pre-procedural preparation prior to surgery. The consulting room where
children are prepared contains a large x-ray machine which may be off putting to some
children. A cover could be placed over this to minimise its impact in the room. All policies
and procedures appropriately reflect the needs of children

Staff Qualifications, Training and Availability to Meet the Needs of Children
The Registered Children’s Nurse provides special expertise and advice and leads on the
Children’s Care on the designated dental lists. The particular issues of the nursing care of
children are understood by all the disciplines in the Clinic. Best and latest evidence based
practice is shared between the Children’s Nurses from the other Children’s Dental Clinics
in the group.

Facilities and Equipment to Meet the Needs of Children
Children are treated on designated children’s lists in an appropriate child and family
friendly environment. Great care and emphasis is taken by the Paediatric Nurse and other
clinic staff in the pre procedural preparation of the children and their families. The bright
friendly atmosphere helps put children at their ease. There is a wide range of age
appropriate toys, activities and games available and a toy cleaning policy with evidence of
its implementation is in place.

Valid Consent of Children

The consent form has space for the identification of the consent giver which is being used
to identify the individual and their relationship with the patient.

Consent recording does not currently routinely include the child patient. The signature of
the child, indicating the understanding of the proposed care would be useful. A 14 year
old patient had treatment provided using parallel consent with both mother and patient
signing their agreement to care. Assessment of competence would be a matter for the
person obtaining consent.

The issues around consent in children are fully taken into consideration and an excellent
example of this was seen on the day of inspection. An older child refused treatment due
to extreme anxiety. The child’s stress could not be allayed despite good and adequate
preparation, extra time given to relax and prepare and the team’s best multi-disciplinary
efforts to explain and reassure the child. A further appointment was arranged in this case.
Comprehensive consent policies and documentation are in place with children having the
opportunity to sign parallel consent.

The patient satisfaction surveys reflect the excellent Clinic practice.

Meeting Children’s Needs During Surgery
There is a clear safe policy and both written and verbal instructions given to children and
their families to advise about the minimum fasting periods needed before dental surgery.
Strict attention is paid to checking that the recommended fasting period as been adhered
PP/SF/Kensington Court Dental Clinic- 0708/                                                19
to. Where there is any doubt the procedure is cancelled and a further appointment made.
Some children on afternoon lists may have long periods of fasting where families do not
comply exactly with the recommended fasting advice.

Care and monitoring arrangements both during and post surgery reflect best practice.

Pain Management for Children
Children’s pain is appropriately assessed using good preparation techniques, distraction
therapies, clinical judgement and the relevant pain assessment scales. Topical Analgesia
pre procedure and other analgesia for the relief of pain is appropriately and safely given
following being ‘double checked’ in accordance with safe medication policies and
procedures. Clear verbal and written discharge advice on the time Analgesia was given in
Clinic and the benefit of the further use of analgesia at home reflects excellent practice.

Transfer of Children
Safe policies, procedures and practice are in place with all staff providing clinic sessions
being appropriately qualified and trained in Paediatric Advanced Life Support skills. A
protocol for emergency transfer arrangements is agreed and in place.


Requirements made since the last inspection report which have been met:
            Action Required           When Completed        Regulation Number
Discontinue the use of the ‘Names November 2006            Regulation 8(1)(f)
List’, contemporaneous record, modify
the care plan to accommodate the
signatures of the recovery nurse,
discharging nurse and carer.


New requirements from this inspection:
            Action Required             When Completed              Regulation Number
Consider covering the X-ray machine October 2007                   Regulation 35(b)
to reduce its visual impact on children
in the pre procedure preparation room.




PP/SF/Kensington Court Dental Clinic- 0708/                                               20
  SURGERY (INCLUDING DENTAL TREATMENT UNDER GENERAL ANAESTHESIA)

Documented Procedures for Surgery –
Inspector’s findings:
Pre and Post Operative Instructions
Printed details were reiterated during consent and prior to discharge. Communications
with parents clearly readable. A leaflet on the prevention of dental caries is available and
was used with parents when the opportunity arose.

Children and their families receive comprehensive preoperative assessment and consent
issues are thoroughly explored. Communications with parents clearly readable. The child
is also able to give and sign own consent if of sufficient understanding, ‘Fraser
Competent’.

Children receive safe care during their procedures, recovering normally within appropriate
timescales.

Anaesthesia and Recovery
Children and their families receive comprehensive preoperative assessment and consent
issues are thoroughly explored. The child is also able to give and sign own consent if of
sufficient understanding, ‘Fraser Competent’.

Children receive safe care during their procedures, recovering normally within appropriate
timescales.

Facilities for Carrying Out Surgery (including general anaesthesia for dental
treatment) - Operating Theatres

Appropriate equipment and facilities are available including an appropriate range of drugs
for procedures, pain relief and resuscitation.

There are safe and appropriate Health and Safety policies relating to drugs, anaesthetic
equipment, risk management, including latex allergy. Ventilation to the operating area
does not allow direct input of fresh air from outside, the air conditioner is of a recycling
type. A complaint’s procedure is in place with information available for both families and
children.

Procedures Specific to Dental Treatment under General Anaesthesia
Children only session observed. Care pathway in use (multi-disciplinary use). Safe and
appropriate care and treatment was seen. One older child attending the Clinic on the day
of inspection had an extreme anxiety attack requiring a postponement of treatment until
the appropriate supportive ‘preparation for treatment’ measures could be put into place.
There was no pressure or coercion of the child and a further appointment was made. The
Clinic staff demonstrated excellent practice in relation to Consent Issues and the child’s
refusal of treatment.

There are clear, safe policies and procedures in place to afford children safe and effective
treatment and care at the Clinic.

Children receive the appropriate level of preparation, care and monitoring by suitably
trained and qualified staff. Discharge arrangements are safe, clear and supported by the
appropriate verbal and written information. An Out of Hours (07000) phone number is
available to patients after treatment.
PP/SF/Kensington Court Dental Clinic- 0708/                                            21
Arrangements for Immediate Critical Care
All patients are ASA 1 or 11. Initial critical care is available in surgery prior to transfer to
another facility. Record keeping evidenced following incident requiring the hospital
treatment of an ambulant patient subsequent to dental general anaesthetic (GA).



Good practice Recommendations:
When re printing advice sheets etc consider assessment of readability.
Consideration should be made to levels of humidity from the decontamination facility.




PP/SF/Kensington Court Dental Clinic- 0708/                                                   22
                                         CRITICAL CARE

Arrangements for Immediate Critical Care
Inspector’s findings:
All patients are ASA 1 or 11
Initial critical care is available in surgery prior to transfer to another facility.




PP/SF/Kensington Court Dental Clinic- 0708/                                            23
                                 ACTION PLAN FROM REPORT


Inspector’s findings:
The focus of the inspection and report for this year has been to report on compliance with
the requirements made previously in the context of the compliance with standards and
regulations made under the Care Standards Act 2000.

Submission of a detailed action plan in relation to the 0 outstanding and 9 new
requirements is required as a result of this report as set out below.



New requirements from this inspection:
            Action Required             When Completed            Regulation Number
i. HIW requires the submission of an 30 October 2007 and         Section 31 (1) Care
action plan addressing all the 3 monthly thereafter.             Standards Act 2000
requirements made this year and those                            The registration authority
carried forward in this report.                                  may at any time require a
                                                                 person who carries on or
The action plan must clearly identify                            manages an establishment
1. the requirement,                                              or agency to provide it with
2. the action to be taken,                                       any information relating to
3. person responsible,                                           the establishment or agency
4. due date for completion,                                      which     the     registration
                                                                 authority           considers
5. and a status report as of the day of                          necessary or expedient to
    the action plan.                                             have for the purposes of its
6. The plan must be reviewed 3                                   functions under this Part.
    monthly, and a copy submitted to
    HIW on the last day of the third
    month until all requirements have
    been met.



Inspector’s Name: P Price                     Date: 15th November 2007
Inspector’s Signature:




PP/SF/Kensington Court Dental Clinic- 0708/                                                  24

								
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