We carried out this announced inspection on 12 June 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?
These questions form the framework for the areas we look at during the inspection.
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 not providing well-led care in accordance with the relevant regulations.
Background
Bupa – Mill Street, Sidmouth is in Sidmouth and provides predominantly NHS and some private treatment to adults and children.
There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.
The dental team includes five dentists, four dental nurses, five trainee dental nurses, two dental hygienists, one receptionist and one practice manager/dental nurse. The practice has four treatment rooms.
The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Bupa – Mill Street, Sidmouth was the practice manager.
On the day of inspection, we collected four CQC comment cards filled in by patients. Three comment cards gave us a positive view of the practice, one was more critical.
During the inspection we spoke with the staff on duty, a practice manager from another Bupa dental service (covering in the absence of the practice manager) and a compliance lead for Bupa. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open: Monday to Friday 8.30am – 5pm.
Our key findings were:
- Staff knew how to deal with emergencies.
- The practice had systems to help them manage risk to patients and staff.
- The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The provider had thorough staff recruitment procedures.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- Staff were providing preventive care and supporting patients to ensure better oral health.
- The appointment system took account of patients’ needs. Patients reported they often experienced delays in timekeeping on the day of their appointment.
- The leadership at the practice was ineffective and was not resulting in a culture of continuous improvement.
- Staff felt improvements could be made to work better as a team.
- The provider asked patients for feedback about the services they provided. However, survey results lacked a plan of action to improve services.
- The provider was not dealing with complaints efficiently.
- The provider had suitable information governance arrangements.
We identified regulations the provider was not complying with. They must:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Send CQC a written report setting out what governance arrangements are in place and the plans to make improvements.
Full details of the regulation the provider is not meeting is at the end of this report.
There were areas where the provider could make improvements. They should:
- Review the practice’s sharps procedures to ensure the practice is following the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
- Review the system for tracking and monitoring the use of NHS prescription pads in the practice.
- Review the practice’s protocols to ensure an antimicrobial audit is undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, all practice audits have documented learning points and the resulting improvements can be demonstrated.
- Review the practice’s infection control procedures and protocols, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
- Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
- Review the supervision needs of individual staff members at appropriate intervals and ensure trainee nursing staff receive adequate clinical supervision and leadership.
- Review the practice's systems for checking and monitoring equipment, taking into account relevant guidance and ensure that all equipment is well maintained. In particular, all equipment brought into the practice by visiting dental implantologists.
- Review the practice's processes and systems for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.
- Review the practice's complaint handling procedures and establish a system for honest and transparent, handling and responding to complaints, including noting any learning points to prevent future similar complaints.
- Review the practice’s protocols and procedures in relation to the Accessible Information Standard to ensure that the requirements are complied with.
- Review the practice radiation protection file to ensure procedures and policies reflect IRMER regulations (2017).
- Review the practice arrangements for ensuring good governance and leadership are sustained in the longer term.