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Inspection Summary


Overall summary & rating

Updated 15 November 2016

We carried out an announced comprehensive inspection on 19 September 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

Dental Health Care is a private dental practice situated in Hertford, Hertfordshire. The practice provides general dental treatment to adults and children.

The practice is situated in a converted period building and free parking is available on site.

The practice employs two dentists, a dental hygienist, a dental nurse and a practice manager who is also a qualified dental nurse. Currently a dentist is only available at the practice on a Monday and Tuesday, although the practice intends to extend this and is actively recruiting to affect this.

The practice is currently open Monday 8.30 am to 6 pm, Tuesday 8.30 am to 7 pm. On Wednesday the practice is closed but advice can still be sought via the practice mobile phone. Thursday and Friday the practice is open for enquiries only. Occasional Saturday appointments can be arranged in advance.

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.

18 patients provided feedback about the service by way of comment cards we left at the practice for the two weeks leading up to our visit. These were overwhelmingly positive and references made to the excellent advice received and how friendly and professional the staff were.

Our key findings were:

  • The practice was visibly clean and clutter free.

  • Patients reported that staff were caring and helpful and that they were usually seen on time.

  • Infection control standards met national guidance.

  • A new patient appointment at the practice could be secured within two weeks.

  • The practice had emergency medicines and equipment in line with national guidance.

  • Clinicians used nationally recognised guidance in the care and treatment of patients.

  • Recent staff changes had rendered some marketing as potentially misleading to the public. This was immediately rectified by the practice.

  • The practice had a cone beam computered tomography machine. Recommendations from the Radiation Protection Advisor had not been met, and so the practice took the machine out of use until such time as standards were met.

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

  • Review the protocols and procedures for use of X-ray equipment giving due regard to guidance notes on the Safe use of X-ray Equipment.

  • 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 training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.

  • 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 of various aspects of the service, such as radiography to help improve the quality of service. Practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
Inspection areas

Safe

No action required

Updated 15 November 2016

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

The practice had emergencies medicines and equipment in line with national guidance to treat medical emergencies. The practice had undertaken recent training in medical emergencies.

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

We found areas where improvements should be made relating to the safe provision of treatment; the cone beam computered tomography machine did not meet national standards, and was immediately taken out of use by the practice until such time as standards are met.

Effective

No action required

Updated 15 November 2016

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

Staff were appropriately registered in their roles, and had access to ongoing training and support.

Dentists used nationally recognised guidance 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.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and it’s relevance in obtaining consent for patients who may lack capacity to consent for themselves.

Caring

No action required

Updated 15 November 2016

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

The practice demonstrated how patient details were kept confidential. No paper records were kept on the premises that could be overseen.

Written treatment plans were generated for patients to consider including the costs involved in treatment.

Patient comments on the service were positive and indicated that staff were friendly and professional.

Responsive

No action required

Updated 15 November 2016

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

Although a dentist was only available at the premises two days a week, a trained dental nurse was available for patients to speak to and offer advice until 10 pm every day. The nurse would refer patients to a dentist where necessary. The number for this service was available on the answerphone.

The practice offered evening appointments once a week for both a dentist and a hygienist to offer flexibility to those patients who may have commitments during normal working hours.

The practice had a complaints policy in place. Complaints could also be made via a link on the practice’s website (this functionality was established during our visit).

Well-led

No action required

Updated 15 November 2016

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

The practice had undergone recent changes in staff and employment of a new practice manager. The practice manager was in the process of overhauling the governance procedures for the practice and we were able to see areas where this was now in place.

Clinical audit was being used as a tool to identify where improvements could be made, although action plans were not always drawn up to effect improvements.

The practice was obtaining patient feedback, and using focussed surveys to ascertain patient reactions to changes in the practice.