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Inspection Summary


Overall summary & rating

Updated 17 February 2017

We carried out an announced comprehensive inspection on 16 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

The Dental Implant Clinic is an implant training clinic based in Bath. The practice also provides other specialist dental treatment including restorative dental treatment, periodontics (specialised gum treatments) and adult orthodontics (the treatment of jaw and tooth irregularities). Patients who use the service are sometimes referred by their own dentists, and others self-refer. Treatment under conscious sedation is provided for patients who are very nervous about undergoing the surgical element of dental implant treatment. Given the nature of the treatments offered, very few, if any, patients under the age of 18 are treated at the clinic.

The practice is based in an adapted domestic dwelling situated near Bath. The practice had five dental treatment rooms, two of which are based on the ground floor. There was a separate decontamination room used for cleaning, sterilising and packing dental instruments. The practice opening hours are 8.45am - 5. 30pm Monday to Friday, the practice is closed at weekends. There were arrangements in place to ensure patients receive urgent medical assistance when the practice was closed.

The practice owner/ principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

We reviewed seven CQC comment cards that had been left for patients to complete prior to our visit and spoke with four patients. Patients commented they found the practice exemplary and staff were welcoming, friendly kind and caring. Several patients commented that staff go out of their way to help.

Patients commented staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained to them so they could make an informed decision which gave them confidence in the care provided. Thank you cards seen in the practice and on the website and the comment cards reviewed corroborated these comments.

Our key findings were:

  • We found the practice ethos was to provide high quality patient centred implant and other specialist treatment in a relaxed and friendly environment.

  • Staff we spoke with were committed to providing a quality service to their patients.
  • Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
  • Infection control procedures were effective and the practice followed published guidance. The practice appeared clean and well maintained.
  • Patients’ needs were assessed, and specialist care and treatment were delivered, in accordance with current legislation, standards and guidance.

  • Conscious sedation was provided in accordance with guidelines published by the Royal College of Surgeons and Royal College of Anaesthetists.

  • Patients received information about their care, proposed treatment, costs, benefits and risks and were involved in making decisions about it. They had access to a treatment co-ordinator who ensured patients fully understood the proposed treatment.
  • We were shown a comprehensive system was in place to gain valid informed consent from patients prior to treatment.
  • Patients could access treatment and urgent and emergency care when required.
  • There was a policy and procedure in place for recording adverse incidents and accidents. Evidence seen demonstrated learning from incidents took place and was shared across the practice team.
  • We saw the practice had clinical governance and risk management structures in place although these could be strengthened to improve their effectiveness. For example in closer monitoring of staff training and the renewal of risk assessments by competent persons e.g. fire.
  • Staff had received training appropriate to their roles and were supported in their continuing professional development by the principal dentist

  • CQC patient comment cards gave a positive picture of a caring, professional and high quality service.

  • Patients were treated with kindness, dignity and respect, and their confidentiality was maintained.

  • The appointment system met the needs of patients, and emergency appointments were available.

  • Services were planned and delivered to meet the needs of patients and reasonable adjustments were made to enable patients to receive their care and treatment.

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

  • Review the practice infection control procedures and provide an annual statement about the practices’ infection control systems and processes giving due regard to the Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
  • Review policies and practices relating to fire management and ensure fire risk assessments are completed in a timely manner and identified actions implemented.
  • Review systems for staff recruitment to ensure all relevant information is current.

Review systems for monitoring staff training and ensuring mandatory training is up to date.

Inspection areas

Safe

No action required

Updated 17 February 2017

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

The practice had effective arrangements for essential areas such as infection control, clinical waste control, management of medical emergencies at the practice and dental radiography (X-rays). There were clear procedures regarding the maintenance of equipment and the storage of medicines in order to deliver care safely and in an emergency. All the equipment used in the dental practice was well maintained.

We were shown the practice had implemented effective governance systems to underpin the provision of safe conscious sedation. The practice took their responsibilities for patient safety seriously and staff were aware of the importance of identifying, investigating and learning from patient safety incidents.

There were sufficient numbers of suitably qualified staff working at the practice. Staff had received safeguarding training and were aware of their responsibilities regarding safeguarding children and vulnerable adults. The practice carried out and reviewed risk assessments to identify and manage risks for the safety of patients.

Effective

No action required

Updated 17 February 2017

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

The practice kept detailed electronic records of the care given to patients including comprehensive information about patients’ oral health assessments, treatment and advice given. The dental care provided was evidence based and focussed on the needs of the patients. The practice used current national professional guidance including that from the National Institute for Health and Care Excellence (NICE) to guide their practice. Conscious sedation was provided in accordance with guidelines published by the Royal College of Surgeons and Royal College of Anaesthetists.

We saw examples of good teamwork within the practice and evidenced good communication with other dental professionals. The practice was proactive in providing patients with advice about preventative care and supported patients to ensure better oral health in line with Public Health England publication ‘Delivering better Oral Health 3rd edition. (DBOH). Comments received via the CQC comment cards reflected patients were very satisfied with the assessments, explanations, the quality of the dentistry and outcomes they experienced. In the waiting rooms we saw evidence of health promotion information.

Staff we spoke with told us they had accessed specific training in the last 12 months in line with their professional development plan and the General Dental Council requirements for registrants.

Caring

No action required

Updated 17 February 2017

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

We reviewed seven completed CQC comments and obtained the views of four patients on the day of our visit about the care and treatment they received at the practice. These provided a positive view of the service the practice offered. Patients commented on the excellent service they received, professionalism and caring nature of the staff and ease of accessibility in an emergency. Patients commented they felt involved in their treatment and that it was fully explained to them.

On the day of the inspection we observed privacy and confidentiality were maintained for patients using the service. Policies and procedures in relation to data protection, security and confidentiality were in place and staff were aware of these.

Responsive

No action required

Updated 17 February 2017

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

We obtained the views of four patients on the day of our visit. These provided a positive view of the service the practice provided. All patients told us the quality of care was very good. Patients commented on the friendliness and helpfulness of the staff and told us dentists were good at explaining the treatment that was proposed. There were clear instructions for patients requiring urgent care when the practice was closed.

The practice had steps into it however we observed there was a portable ramp available to enable patients in wheelchairs or with mobility difficulties to access the practice. There were two ground floor treatment rooms once in the practice.

The service was aware of the needs of patients who were referred to them and took these into account in how the practice was run. Patients could access treatment and urgent and emergency care when required.

There was a procedure in place for acknowledging, recording, investigating and responding to complaints and concerns made by patients or their carers.

Well-led

No action required

Updated 17 February 2017

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

The practice had a management structure and governance arrangements in place which consisted of the principal dentist, the practice manager and lead dental nurse who were responsible for the day to day running of the practice. We saw the practice had clinical governance and risk management structures in place although these could be strengthened to improve their effectiveness. For example greater attention to review risk management processes requiring an external competent person. The practice carried out a programme of audits as part of a system of continuous monitoring, improvement and learning.

Effective clinical 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. There were arrangements for sharing information across the team, including holding practice based staff meetings and the use of email. All information shared was documented for those staff unable to attend meetings.

Staff told us they felt well supported and could raise any concerns with the principal dentist. All the staff we met said they were happy at the practice and enjoyed the opportunities presented to gain knowledge and skills which enhanced their professional development. They told us the practice was a good place to work.

The practice had systems in place to seek and act upon feedback from patients using the service.