Archived: Kingswood Dental Centre

Updated 20 June 2016

This inspection took place on 18 January 2016. The inspection team consisted of a Care Quality Commission (CQC) inspector, a second inspector and a dental specialist advisor.

Prior to the inspection we reviewed information we held about the provider. We informed NHS England area team we were inspecting the practice; however we did not receive any information of concern from them.

We also reviewed information we asked the provider to send us in advance of the inspection. This included their latest statement of purpose describing their values and objectives, a record of any complaints received in the last 12 months and details of their staff members together with their qualifications and proof of registration with the appropriate professional body.

During the inspection we toured the premises and spoke with practice staff including, the dentists, dental nurses and receptionists. To assess the quality of care provided we looked at practice policies and protocols and other records relating to the management of the service.

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 20 June 2016

We carried out an announced comprehensive inspection on 18 January 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 this practice was not 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 not providing well-led care in accordance with the relevant regulations

Background

Kingswood Dental Centre is situated at one end of the main street in the Kingswood area of Bristol. It has five surgeries a waiting area and reception area. It provides general dentistry, including endodontics and restorative services, to NHS patients, but will also treat private patients. The split is approximately 80% NHS and 20% private treatments There is a car park at the rear of the practice with a provision for 'Disabled Parking'. Wheelchair access to the practice is via the rear entrance to the building and there is a disabled toilet facility.

The practice has five full time dentists and two part time dentists one of whom only worked on Saturday mornings. Supporting the dentists are six qualified dental nurses and a trainee dental nurse; a practice manager and three part time receptionists. The practice also has a dental hygienist two days a week who offers private only treatments.

There is no registered manager at the practice. 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.

The practice is open Monday to Wednesday from 7.30am - 7.30pm Thursday from 8.30am - 7.00pm Friday 9.00am - 5.00pm and Saturday from 9.00am - 1.00pm. The practice is closed Saturday afternoons and all day Sunday.

The practice had not received any CQC comment cards for patients to complete, prior to our visit, about the services provided. However we looked at the 17 practice feedback forms for the month of November and saw positive comments about the practice and practitioners. In addition we spoke with nine patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice. They commented staff put them at ease, listened to their concerns and they had confidence in the dental services provided. We saw the practice had received eight complaints in the last 12 months which related to poor care and treatment; long waiting times; lack of appointments and unhelpful staff.

Our key findings were:

• The practice mostly carried out oral health assessments and planned treatment in line with current best practice guidance, for example from the Faculty of General Dental Practice (FGDP). Patient dental care records were detailed and showed on-going monitoring of patients oral health for some but not all dentists.

• Dental care records did not always have an up to date medical history recorded and there was limited evidence of preventive practice to maintain and improve patients’ oral health.
• There were systems in place to help ensure the safety of staff and patients with regard to safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies. However there were ineffective systems to manage the safety of staff and patients in the premises and from equipment used.

• The practice was seen to be clean and tidy; and appeared well organised with instruments correctly stored. There were systems and procedures in place for infection prevention and control. Decontamination procedures in place met the essential requirements as required by legislation.
• Staff were supported to maintain their continuing professional development and had undertaken training appropriate to their roles. However they did not feel well supported in their work.

• Patients commented they felt involved in their treatment and that it was fully explained to them. We reviewed 17 practice feedback cards completed by patients. Common themes were patients felt they received very good care in a clean environment from a helpful practice team.

• The practice had an efficient appointment system in place to respond to patient’s needs. Patients were mostly able to make routine and emergency appointments when needed although some feedback seen reported long waiting times and lack of appointments. There were clear instructions for patients regarding out of hours care.

• The dental practice did not have effective clinical governance and risk management processes in place for health and safety management and monitoring the safety and quality of service provision.

• The practice did not have a comprehensive system to monitor and continually improve the quality of the service through a detailed programme of clinical and non-clinical audits.

• The practice did not have an accessible and visible leadership team with clear means of sharing information with staff.

There were areas where the provider must make improvements and must:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking the regulated activities in a timely way. This to include learning from accidents and incidents and how they are shared with practice staff to mitigate risks and improve safety and quality of service.
• Ensure the training, learning and development needs of staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff employed.
• Ensure all dental care records are maintained appropriately, including patients medical history, giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

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

• Review the practice arrangements for further assessment and referral where high scores for gum disease are found.

• Review the systems and procedures and implement a system to check all staff have completed mandatory training and appropriate continuing professional development.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’