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Inspection Summary


Overall summary & rating

Updated 9 October 2018

We undertook a focused inspection of Barton Dental Surgery on 20 September 2018. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector.

We undertook a comprehensive inspection of Barton Dental Surgery on 15 February 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing well led care in accordance with the relevant regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Barton Dental Surgery on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area where improvement was required.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 15 February 2018.

Background

The practice is located in Barton Le Clay in central Bedfordshire. It provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. There are no patient car parking facilities available; although patients with disabilities can be offered a space in the practice’s private car park. Public roadside car parking is available within a short walking distance of the practice.

The dental team includes three dentists, four dental nurses (including the head nurse), one trainee nurse, one dental hygienist and one receptionist. The head nurse was also undertaking management duties and had taken on the role of practice coordinator.

The practice has three treatment rooms; two of these are on the ground floor.

The practice is owned by a partnership 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 Barton Dental Surgery is one of the dentists who owns the practice.

We were advised on the day of our comprehensive inspection that two of the four partners had left. We told the principal dentist to take action to ensure the CQC registration of the practice is correct. We found that the registration of the practice was still not correct at the time of our follow up visit. The dentist who owns the practice told us they had been making efforts to resolve the issues.

The practice is open: Monday, Tuesday, Wednesday, Thursday from 8.30am to 4.30pm and Friday from 8.30am to 2pm. The practice is closed at lunchtimes from 1pm to 2pm Monday to Wednesday and from 2pm to 3pm on Thursday.

Our key findings were:

  • The practice had implemented a policy and process for reporting and investigating significant events.

  • The practice had improved systems for monitoring and improving quality, for example audit activity.

  • A policy for safeguarding vulnerable adults had been implemented.

  • A risk assessment had been conducted for the non-clinical staff member working without disclosure barring service (DBS) check clearance. The practice had ensured that clinical staff had a DBS check in place.

  • A policy had been implemented regarding staff employment and recruitment. We saw that policy was being applied in relation to the appointment of new staff.

  • The practice had implemented a system for the review and action of patient safety and medicines alerts from the Medicines and Healthcare Products Regulatory Authority (MHRA).

  • The risks presented by legionella and fire were being effectively addressed.

  • The practice had obtained rectangular collimators for their X-ray equipment.

  • The practice had started to take steps by encouraging clinicians to follow the guidelines issued by the British Endodontic Society regarding the use of rubber dam.

  • Waste handling protocols had been reviewed and now reflected guidance issued in the Health Technical Memorandum 07-01 (HTM07-01).

  • Prescription pad security had been improved.

  • Staff were up to date with their mandatory training and continuing professional development (CPD).

  • Staff had completed or were in the process of completing training in the Mental Capacity Act (MCA) 2005.

  • The practice had not yet taken action regarding the installation of a hearing loop to assist those who used a hearing aid. An external agent was due to undertake a risk assessment of the premises.

There were areas where the provider could make improvements. They should:

  • Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

Inspection areas

Safe

No action required

Updated 26 April 2018

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

Premises and equipment were clean and properly maintained. The practice followed national guidance for cleaning, sterilising and storing dental instruments, although we found that some improvements could be made.

Staff received training in basic life support. The practice had some suitable arrangements for dealing with medical and other emergencies. We noted that some items of equipment and medicines were missing on the day of our inspection. Immediate action was taken by the practice and an order was placed to obtain the items.

A number of staff had required training in safeguarding at the time of our inspection. This was completed immediately after our inspection took place. Whilst the practice had implemented a safeguarding policy for children, this did not include information about vulnerable adults.

Staff were qualified for their roles, but the practice had not completed essential recruitment checks or received assurance that all staff were suitable to undertake their roles.

The practice did not demonstrate that they used learning from incidents to help them improve. The practice had not implemented an effective policy and procedure for the reporting of untoward incidents. Following our inspection, we were provided with a newly implemented incident reporting policy.

Effective

No action required

Updated 26 April 2018

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

The dentists assessed patients’ needs and provided care and treatment in line with recognised guidance. In the sample of dentist completed patient records we looked at, we noted that the detail of record keeping could be improved.

Patients described the treatment they received as excellent, professional and first class. One of the dentists told us they discussed treatment with patients so they could give informed consent.

The practice had arrangements when patients needed to be referred to other dental or health care professionals, but monitoring systems required strengthening.

The practice had not implemented a formal induction programme, although no new staff had been appointed recently. Staff had received annual appraisals.

The principal dentist understood their responsibilities under the Mental Capacity Act 2005 when treating adults who may not be able to make informed decisions. The dentist had undertaken Mental Capacity Act training. Dental nurses had not completed training in the Act.

Caring

No action required

Updated 26 April 2018

We found that this practice was providing caring services in accordance with

the relevant regulations.

We received feedback about the practice from 20 people. Patients were positive about all aspects of the service the practice provided. They told us staff were polite, considerate and caring. They said that they were given helpful and informative explanations about dental treatment, and said their dentist listened to them. Patient comments included that staff made them feel at ease, especially when they were anxious about visiting the dentist.

We saw that staff protected patients’ privacy and were aware of the importance of confidentiality. Patients said staff treated them with dignity and respect.

Responsive

No action required

Updated 26 April 2018

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

The practice’s appointment system was efficient and met patients’ needs. Patients could get an appointment quickly if in pain.

We found that not all patients’ different needs were identified. The practice had step free access and patients with wheelchairs were seen in a larger treatment room on the ground floor. Whilst patient toilet facilities were available these had not been modified or adjusted for patients with mobility problems. The practice did not have a hearing loop installed.

The practice did not have access to information in different formats or languages or access to an interpreter service. Staff told us that they did not consider that existing patients or other people in the community would benefit from an interpreter service.

The practice took patients’ views seriously. They valued compliments from patients and had processes to respond to concerns and complaints efficiently. We noted that any discussions held amongst staff to share learning and improve the service had not been documented.

Well-led

No action required

Updated 9 October 2018

We found that this practice was providing well-led care in accordance with

the relevant regulations.

The provider had made improvements to the management of the service. This included: implementing policies and improving procedures such as recruitment, addressing the risks presented by legionella and fire, implementing a system for the review and action of patient safety medicines alerts and improving the quality of audit activity.

The improvements provided a sound footing for the ongoing development of effective governance arrangements at the practice.