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Inspection Summary


Overall summary & rating

Updated 8 September 2016

We carried out an announced comprehensive inspection on 19 July 2016 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 that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Greenleaves Dental Practice is a general dental practice situated in the town of Potters Bar, Hertfordshire. It provides general dentistry to adults and children funded by the NHS or privately. They also offer the placement of implants (where a metal post is placed surgically into the jaw bone to support a tooth or teeth) and offer treatment under conscious sedation (these are techniques in which the use of a medicine or medicines produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation).

The practice is situated on the high street in Potters Bar with good public transport links, and free car parking a short walk from the practice.

The practice is open from 8 am to 7 pm on Monday and Tuesday, 8 am to 6 pm on Wednesday and Thursday, 8 am to 5pm on Friday and 8 am to 3 pm on a Saturday.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

Prior to our visit we left comment cards at the practice which we collected on the day of the inspection. 28 patients provided feedback about the service in this way. Patients reported very positively about the service.

Our key findings were:

  • The practice was visibly clean and clutter free.

  • Patients reported positive experiences at the practice and commented that they were treated with care and understanding.

  • The practice could normally arrange a routine appointment within one to two days and emergency appointments mostly on the same day.

  • The practice offered evening and Saturday appointments to allow flexibility for those with commitments during normal working hours.

  • There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.

  • The practice had all the emergency equipment recommended by the Resuscitation Council UK for use in a medical emergency, and all emergency medicines as recommended in the British National Formulary.

  • The clinicians used nationally recognised guidelines in the care and treatment of patients.

  • X-ray machines, although serviced, had not been tested for dose within the recommended three years, although this was arranged shortly following the inspection.

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

  • Establish whether the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.

  • Review the practice’s protocols for conscious sedation, giving due regard to 2015 guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

  • Review the practice's recruitment policy and procedures to ensure character references for new staff as well as proof of identification are requested and recorded suitably.

  • Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development.

  • Review the practice’s audit protocols for completion of infection control audits at regular intervals to help improve the quality of service. Practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

  • Review the procedures to track referrals made to other services, and ensure that this is used consistently.
Inspection areas

Safe

No action required

Updated 8 September 2016

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

The practice had emergency medicines and equipment in place in line with national guidance. These were regularly checked and stored together in one bag to allow rapid access if a situation arose requiring it.

Infection control standards met those outlined in the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices.’ published by the Department of Health.

X-ray machines had been recently services, but not tested within the recommended three years. In addition the practice did not have an appointed Radiation Protection Advisor (RPA) to help oversee that radiation safety on the premises. Immediately following the inspection an RPA was appointed and testing of all the X-ray equipment was arranged.

Effective

No action required

Updated 8 September 2016

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

The practice used national guidelines in the care and treatment of patients.

The practice carried out a comprehensive screening of the oral condition as well as soft tissues of the face and neck.

All qualified staff were registered with the General Dental Council.

Caring

No action required

Updated 8 September 2016

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

Patients commented that clinicians were skilled at treating nervous patients and children, and were able to put them at ease.

Staff described the processes in place to maintain confidentiality within the practice.

Responsive

No action required

Updated 8 September 2016

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

A routine check-up appointment could be made within a couple of days, and the practice endeavored to see any patient phoning in pain on the same day.

Out of hours patients were directed to the NHS 111 service or to the mobile number for the principal dentist.

The practice offered flexible appointment times, with evening appointments available two days a week, and Saturday appointments every week.

Well-led

No action required

Updated 8 September 2016

We found that this practice was providing well-led care in accordance with the relevant regulations.

The practice had recently appointed a new practice manager who was in the process of updating all the governance procedures in the practice. Although this work was not yet complete the resulting improvements were clear.

The practice used audit tools to monitor and improve the service; however infection control audits had not been completed since October 2013. Following our inspection this was carried out and a protocol put in place to ensure its timely completion in the future.