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Inspection Summary


Overall summary & rating

Updated 16 March 2017

We carried out an announced comprehensive inspection on 17 January 2017 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 not providing well-led care in accordance with the relevant regulations.

Background

Castle Dental Practice is a dental practice providing NHS and private treatment for both adults and children. The practice is based in a converted office based in Portchester, a town close to Portsmouth, in south Hampshire.

The practice has three dental treatment rooms all of which are based on the ground floor and a separate decontamination area used for cleaning, sterilising and packing dental instruments. The practice is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs two dentists, one hygienist and three dental nurses who also cover reception.

The practice’s opening hours are between 8.30am and 7pm on Monday and Tuesday, 8.30am and 5pm on Wednesday and 8.30am and 12.30pm on Thursday and Friday.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by the principal dentist and an out-of-hours service, via 111.

Dr Martin Law, the principal dentist, is registered as an individual and is legally responsible for making sure that the practice meets the requirements relating to safety and quality of care, as specified in the regulations associated with the Health and Social Care Act 2008.

We obtained the views of nine patients on the day of our inspection.

Our key findings were:

  • We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
  • Clinical leadership was provided by the principal dentist.
  • Appropriate emergency medicines and life-saving equipment were available in accordance with current guidelines.
  • The practice appeared clean and well maintained.
  • There was appropriate equipment for staff to undertake their duties, and equipment was maintained.
  • Infection control procedures generally followed published guidance.
  • The practice had processes in place for safeguarding adults and children living in vulnerable circumstances.
  • There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.
  • Dentists provided routine dental care in accordance with current professional guidelines.
  • The practice carried out intravenous sedation for a small number of patients each year. We found shortfalls in the clinical governance systems that underpinned the provision of conscious sedation.
  • The service was aware of the needs of the local population and took these into account in how the practice was run.
  • Patients could access treatment and urgent and emergency care when required.
  • The practice had some clinical governance and risk management structures in place, but we found several shortfalls in systems and processes.
  • Areas where we found that required improvements were the governance systems underpinning the health and safety systems including fire, infection control, practice records, conscious sedation, safer sharps usage, medicines management and clinical audit.
  • Information from 50 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.

We identified regulations that were not being met and the provider must:

  • Ensure the training, learning and development needs of staff members are collated and reviewed at appropriate intervals.
  • Ensure risk assessments in key areas such as infection prevention and control, recapping needles following administration of local anaesthetic and sedation are carried out.
  • Ensure written policies and procedures are reviewed regularly and updated to reflect changes in legislation and guidelines.
  • Ensure there is a robust system to record, respond and learn from significant events and accidents.
  • Ensure that the governance arrangements for sedation take into account the guidance set out in the Department of Health document, conscious sedation in the provision of dental care 2003.
  • Ensure staff assisting in conscious sedation have the appropriate training and skills to carry out the role.
  • Ensure medicines dispensing follow the secondary dispensing guidelines of the British Pharmacological Society.

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

  • Review the practice’s infection control procedures and protocols taking into account The Health and Social Care Act 2008: Code of Practice about the prevention and control of infections and related guidance. Specifically, the review the use of residual protein testing for the ultrasonic cleaning bath.
  • Provide an annual statement in relation to infection prevention control required under The Health and Social Care Act 2008: Code of Practice about the prevention and control of infections and related guidance.
  • Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
  • Review the monitoring frequency of the emergency oxygen and automated external defibrillator so that they are reviewed at least weekly rather than on the existing monthly arrangements.
  • Review the safety arrangements of the window blinds in the practice, this could include either ensuring the pull cords are made secure or carrying out a suitable risk assessment in relation to the pull cords.
  • Consider the provision of an external name plate providing details of the dentists working at the practice including their General Dental Council (GDC) registration number in accordance with GDC guidance March 2012.
  • Review the contents of the practice website, practice leaflet and NHS Choices to bring information up to date.
  • Review the storage arrangements of the emergency medicines and lifesaving equipment so that they are stored in one central location in the practice.
  • Review the security of the decontamination room which contained prescription only medicines to prevent unauthorised access by the public.
  • Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as Public Health England (PHE).
Inspection areas

Safe

No action required

Updated 16 March 2017

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

The practice had some arrangements in place for essential areas such as infection control, clinical waste control, management of medical emergencies at the practice and dental radiography (X-rays). We noted that improvements were required to the systems and processes underpinning health and safety systems including fire safety, conscious sedation and medicines management. We found that the equipment used in the dental practice was maintained in accordance with manufacturer’s instructions.

There were systems in place for identifying, investigating and learning from patient safety incidents although systems required improving.

Staff were aware of their responsibilities regarding safeguarding children and vulnerable adults and had received safeguarding training but five of the six staff had not been trained to the recommended level.

Effective

No action required

Updated 16 March 2017

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

The dental care provided for routine care was evidence based and focussed on the needs of the patients. The practice used current national professional guidance to guide their practice.

The practice carried out intravenous sedation for a small number of patients each year. We found shortfalls in the clinical governance systems that underpinned the provision of conscious sedation.

We saw examples of positive teamwork within the practice and evidence of good communication with other dental professionals. Staff generally received professional training and development appropriate to their roles and learning needs although there were gaps in training in some areas.

Caring

No action required

Updated 16 March 2017

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

We obtained the views of 50 patients before our visit and nine patients on the day of our visit. These provided a positive view of the service the practice provided.

Patients commented that the quality of care was very good. Patients commented on friendliness and helpfulness of the staff and dentists were good at explaining the treatment that was proposed.

Responsive

No action required

Updated 16 March 2017

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

The service was aware of the needs of the local population and took these into account in how the practice was run.

Patients could access treatment and urgent and emergency care when required. The practice provided patients with access to telephone interpreter services when required.

The practice had three ground floor treatment rooms and level access into the building for patients with mobility difficulties and families with prams and pushchairs.

Well-led

Improvements required

Updated 16 March 2017

We found that this practice was not providing well-led care in accordance with

the relevant regulations.

Leadership was provided by the principal dentist. Staff had an open approach to their work and shared a commitment to continually improving the service they provided.

Staff told us that they felt well supported and could raise any concerns with the principal dentist. All the staff we met said that they were happy in their work and the practice was a good place to work.

The practice generally had some clinical governance and risk management structures in place. We found some areas where improvements must be made.

The governance systems underpinning health and safety systems including fire safety, infection control, practice records, conscious sedation, safer sharps usage, medicines management and the systems for reviewing practice policies

required improvement.