The Care Quality Commission
  • Dentist
  • Dentist

Archived: Hewlett Road Dental Surgery

62A Hewlett Road, Cheltenham, Gloucestershire, GL52 6AH (01242) 234048

Provided and run by:
Dr Andrew Holliday

Important: The provider of this service changed. See old profile

All Inspections

5 October 2017

During a routine inspection

We carried out a focused inspection of Hewlett Road Dental Practice on 5 October 2017.

During the focused inspection of Hewlett Road Dental Practice on 5 October 2017 we saw evidence of a concerning nature which required the focused inspection to change to a comprehensive inspection.

The inspection was led by a CQC inspector, who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 10 February 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

  • Is it safe?
  • Is it effective?
  • Is it caring?
  • Is it responsive to people’s needs?
  • Is it well-led?

When one or more of the five questions is 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 areas where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with regulations 17 and 18 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 Hewlett Road Dental Surgery on our website www.cqc.org.uk.

We reviewed the key question of well-led as we had made recommendations for the provider relating to this key question.

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.

The provider had made insufficient improvements to put right the shortfalls and had not dealt with the regulatory breaches we found at our inspection on 10 February 2017.

Background

Hewlett Road dental surgery is in Cheltenham and provides private treatment to patients of all ages.

There is no level access for people who use wheelchairs and pushchairs. Car parking spaces, including those for patients with disabled badges, are available near the practice.

The dental team includes two dentists, one dental nurse, two dental hygienists and one cleaner. The practice has three treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day we spoke with two patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, one dental nurse, one dental hygienist and one locum dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday 8am to 5:30pm and Friday 8am to 4pm.

10 February 2017

During a routine inspection

We carried out an announced comprehensive inspection on 10 February 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 not providing well-led care in accordance with the relevant regulations.

Background

Hewlett Road Dental surgery is located in the centre of Cheltenham and provides private treatment to adult patients and NHS treatment to children. The practice consists of two treatment rooms, toilet facilities for patients and staff, a reception/ waiting area, office and a staff room. The practice offers routine examinations and treatment.

There are three dentists and two hygienists; three dental nurses; one trainee dental nurse; a decontamination technician and three part time receptionists. The practice is located on the first floor of the building and has a stair lift to enable patients with mobility difficulties to access the practice. The provider has a second practice nearby which is fully wheelchair accessible and arrangements can be made to be seen at that practice.

Fees for private treatments were displayed in information leaflets for patients available in the practice and on the practice website. There were arrangements in place to ensure patients received urgent dental assistance when the practice was closed. This is provided by an out-of-hours service and the arrangements are displayed in the practice and on a telephone answering service.

The principal dentist is the registered provider. 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 –Thursday 8.00am - 5.30pm, Friday 8.00am – 4.00pm. The practice is closed at weekends but the out of hours emergency arrangements are displayed on the website. Contact information is also available from the practice telephone answering service. Emergency appointments are made available each day for patients with dental pain.

We reviewed 20 CQC comment cards that had been left for patients to complete prior to our visit. In addition we spoke with six patients on the day of our inspection.

Feedback from patients was positive about the care they received from the practice. They commented the staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained them so they could make an informed decision which gave them confidence in the care provided.

Patients we spoke with and the comment cards told us staff were kind, caring, competent and put patients at their ease. However some patients told us they were unhappy about the difficulties with appointments being changed or cancelled at short notice in recent months. Staff told us this had now been rectified.

Our key findings were:

  • We found that the ethos of the dentists and the dental hygienist was to provide patient centred dental care in a relaxed and friendly environment.
  • Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
  • The dental treatment rooms appeared clean and well maintained.
  • There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
  • Infection control procedures were effective and the practice followed published guidance.
  • Premises appeared well maintained and visibly clean. Good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation.
  • There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
  • The practice had processes in place for safeguarding adults and children living in vulnerable circumstances. However not all staff had received appropriate training.
  • Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
  • There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.
  • Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
  • Patient dental care records were electronic, detailed and comprehensive.
  • 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 with information for out of Hours service clearly available.
  • We were told staff received training appropriate to their roles and were supported in their continued professional development (CPD). However there was no effective system in place to monitor staff had undertaken or received appropriate training for their roles.
  • Patient feedback during our inspection gave us a positive picture of a friendly, caring, professional and high quality service.
  • The practice had clinical governance and risk management structures in place, but we found several shortfalls in systems and processes underpinning the quality of care provided.

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

  • Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
  • Ensure the practice recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
  • Ensure the training, learning and development needs of staff members are monitored to ensure they undertake appropriate training, collated and reviewed at appropriate intervals.
  • Ensure a performance review system is establish and provides and effective process for the on-going assessment, appraisal and supervision of all staff.

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

  • Review the practice infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance with particular attention to the Annual Infection Control statement.
  • Review maintenance records regarding the electrical hard wiring of the practice.

2nd February 2016

During a routine inspection

We carried out an announced comprehensive inspection on 2nd February 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

Hewlett Road Dental surgery is located in the centre of Cheltenham and provides private treatment to adult patients and NHS treatment to children. The practice consists of two treatment rooms, toilet facilities for patients and staff, a reception/ waiting area, office and a staff room. The practice offers routine examinations and treatment. There are three dentists and two hygienists.

The practice’s opening hours are

8.00 to 17.30 on Monday

8.00 to 17.30 on Tuesday

8.00 to 17.00 on Wednesday

8.00 to 17.30 on Thursday

8.00 to 16.00 on Friday

There is an on-call dentist rota for emergencies out of these times.

We carried out an announced, comprehensive inspection on 2nd February 2016. The inspection took place over one day. The inspection was led by a CQC inspector. They were accompanied by a dental specialist advisor.

Before the inspection we looked at the NHS Choices website. In the last twelve months there had been no comments about the practice.

For this inspection 29 people provided feedback to us about the service through CQC comment cards. Patients were positive about the care they received from the practice. They were complimentary about the service offered which they said was good. They told us that staff were professional, caring, respectful and friendly. Patients told us that the practice was clean and hygienic. We received a few negative comments from seven patients about lack of continuity because of staff changes. Four people commented that there was sometimes a long wait for their appointment.

The 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.

Our key findings were:

• Safe systems and processes were in place, including a lead for safeguarding and infection control.

• Staff recruitment policies were appropriate and most of the relevant checks were completed. Staff received relevant training.

• Risk assessments were in place and they were regularly reviewed.

• The clinical equipment in the practice was appropriately maintained. The practice appeared visibly clean throughout.

•The process for decontamination of instruments followed relevant guidance.

• The practice maintained appropriate dental care records and these were updated.

• Patients were provided with health promotion advice to promote good oral care.

• Written consent was obtained for dental treatment.

• The dentists were aware of the process to follow when a person lacked capacity to give consent to treatment.

• Feedback that we received from patients was mostly positive. Patients said that they received a caring and effective service.

• There were governance systems at the practice such as systems for auditing patient records, infection control and radiographs.

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

  • Review the practice's recruitment policy and procedures to ensure references for new staff are requested and recorded suitably.
  • Review the process for monitoring the defibrillator battery to make sure it is working
  • Review the process for monitoring and recording of the immunity status of all clinical staff
  • Review the system for recording the training and CPD of all staff in the practice so that it is clear that all the staff have up to date relevant training.
  • Review the process for team meetings so that staff discuss developments in the practice such as learning from incidents and complaints.

18 November 2014

During an inspection looking at part of the service

This inspection was carried out to follow up on two compliance actions issued at the last inspection on 30th April 2014.

At the last inspection we found that the practice needed to improve how they maintained people's privacy and dignity. Privacy was not respected as one surgery door was inappropriate in size and closure and one surgery door was open during treatment.

There were no arrangements to identify safeguarding concerns relating to vulnerable adults. There was no procedure for safeguarding vulnerable adults to provide guidance for staff and staff had not completed adults safeguarding training. There was no guidance about how to assess people's mental capacity and complete "best interests" records to protect them from abuse.

The provider wrote to us to tell us how they would address these issues by August 2014.

At this visit we found that one of the surgery doors had been replaced and all the surgery doors were kept closed when patients were having treatment. Two people told us that their privacy and dignity was always respected.

We found that the provider had the telephone number to contact if they wanted to make a referral about abuse to the local safeguarding team. Most of the staff had received training about safeguarding vulnerable adults. There was no written procedure about safeguarding adults from abuse but the three staff we spoke with knew what to do if they were concerned that someone was being abused. We spoke with two people who told us that they felt safe and comfortable with the staff.

Staff had had some training about the Mental Capacity Act 2005. There was a plan to discuss the implications of the Mental Capacity Act in a practice meeting.

30 April 2014

During a routine inspection

When we visited Hewlett Road Dental Surgery we spoke to four patients, a dentists, a dental nurse and a receptionist. We found patients privacy was not always respected as a door to one surgery was inappropriate and did not protect patients dignity. The Patient Guide leaflet required updating to ensure patients had the correct information.

We looked at six treatment records and found there was a detailed record of completed dental assessments and treatment options discussed with the patient. Patients were pleased with the care and treatment they had received and found the staff friendly and polite. Patients told us, "I am satisfied with the dental treatment", "I would thoroughly recommend the dentist" and "the dentist and hygienist are excellent".

Staff had been trained in child protection but had not received training related to safeguarding adults. A lack of information and knowledge about safeguarding vulnerable adults meant any abuse may not be identified and responded to appropriately.

The practice was clean throughout. The staff had followed infection control and the decontamination of instruments procedures to help protect patients' from the risk of infection. Patients told us the practice was always clean. We found quality monitoring audits had been completed to ensure systems were effective. Patients had completed surveys to monitor the quality of the service and action was planned.