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Inspection Summary


Overall summary & rating

Updated 7 September 2016

We carried out an announced comprehensive inspection on 26 May 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

Bute House Dental Surgery is a dental practice providing mostly NHS dental treatment, with private treatment options for patients. The practice is located in premises close to Deal town centre. There is roadside parking in the area.

The practice has four treatment rooms, two of which are on the ground floor.

The practice provides dental services to both adults and children. The practice provides mostly NHS treatment (85%). Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment. Patients also have the option of private treatment options such as implants and cosmetic dentistry.

The practice’s opening hours are – Monday to Friday 8.30am to 5.30pm  and Saturday 8am to 3pm.

Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message or by telephoning the local Dentaline service.

The principal dentist/owner 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.

The practice has seven dentists; four qualified dental nurses three receptionists, one trainee dental nurse and a practice manager.

We did not provide CQC comment cards on this occasion as the inspection was unannounced. We did speak with patients and review feedback that practice had received through the NHS Friends and family test (FFT).

Our key findings were:

• The practice was visibly clean and tidy.

• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.

• Patients at the practice gave mostly positive feedback about their experiences at the practice.

• Patients at the practice gave mostly positive feedback about their experiences at the practice however some patients said they were not always treated with dignity and respect.

• The practice was well equipped.

• Dentists identified the different treatment options, and discussed these with patients.

• Patients’ confidentiality was maintained.

• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilising dental instruments. Apart from consistent use of the illuminated magnifying glass to ensure that all instruments were free of debris and undamaged.

• The practice had the necessary equipment for staff to deal with medical emergencies, and staff had been trained how to use that equipment. This included an automated external defibrillator, oxygen and emergency medicines.

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

 • Review its responsibilities to the needs of people with a   disability  and the requirements of the equality Act 2010 and   consider installing a hearing induction loop at the premises. This would assist patients who used a hearing loop to hear whilst in the practice.

  • Review the use of the illuminated magnifying glass when processing instruments giving due regard to HTM 01-05 for its consistent use.
  • Review the process following sterilisation and ensure that all pouches used to store instruments are dated.
  • Arrange for HSE notification to be obtained and then included in the radiation protection file
  • Review the practices processes for appraisal of staff and the identification of training needs
  • Review staff training in relation to the Mental Capacity Act 2005
  • Create a whistleblowing policy to guide staff should they wish to raise a concern regarding a colleagues performance
  • Review the processes for sharing information with staff to ensure all staff receive information and feedback in a timely way
Inspection areas

Safe

No action required

Updated 7 September 2016

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

All staff had received up-to-date training in safeguarding vulnerable adults and children. There were clear guidelines for reporting concerns and the practice had a lead member of staff to offer support and guidance over safeguarding matters. Staff knew how to recognise the signs of abuse, and how to raise concerns when necessary.

The practice had emergency medicines and oxygen available, and an automated external defibrillator (AED). Regular checks were being completed to ensure the emergency equipment was in good working order.

Recruitment checks were completed on all new members of staff. This was to ensure staff were suitable and appropriately qualified and experienced to carry out their role.However, DBs checks were not robust.

The practice was visibly clean and tidy and there were infection control procedures to ensure that patients were protected from potential risks. The infection control procedures followed the Department of Health guidance HTM 01-05 with the exception of use of the illuminated mangniication device and dates for expiry on pouched instruments.

X-ray equipment was regularly serviced to make sure it was safe for use.

Effective

No action required

Updated 7 September 2016

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

All patients were clinically assessed by a dentist before any treatment began.

The practice was following National Institute for Health and Care Excellence (NICE) guidelines for the care and treatment of dental patients. Particularly in respect of patient recalls, wisdom tooth removal and the non-prescribing of antibiotics for patients at risk of infective endocarditis (a condition that affects the heart).

The practice made referrals to other dental professionals when it was appropriate to do so. There were clear procedures for making referrals in a timely manner.

Caring

No action required

Updated 7 September 2016

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

Patient confidentiality was maintained and electronic dental care records were password protected.

Patients said staff were not always friendly, polite or professional. Feedback from patients identified that they felt they were not always treated with dignity and respect by the reception staff.

Patients said they received good dental treatment and they were involved in discussions about their dental care.

Patients said they were able to express their views and opinions.

Responsive

No action required

Updated 7 September 2016

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

Patients said they were not always able to get an appointment. However, patients who were in pain or in need of urgent treatment would be seen the same day.

The practice had access for patients with restricted mobility via a ramp which would be used to help patients access a small flight of stairs. Some patient areas were located on the ground floor. The practice had completed a disabled access audit to consider the needs of patients with restricted mobility

There were arrangements for emergency dental treatment outside of normal working hours, including weekends and public holidays which were clearly displayed in the practice.

There were systems and processes to support patients to make formal complaints. Where complaints had been made these were acted upon, and apologies given when necessary.

Well-led

No action required

Updated 7 September 2016

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

There was a clear management structure at the practice. Staff were aware of their roles and responsibilities within the dental team, and knew who to speak with if they had any concerns.

The practice was carrying out regular audits of both clinical and non-clinical areas to assess the safety and effectiveness of the services provided.

Staff said the practice was a friendly place to work, and they could speak with the dentists if they had any concerns.