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Inspection Summary


Overall summary & rating

Updated 8 March 2017

We carried out an announced comprehensive inspection on 18 January 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 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

Warren House Dental Care is situated in Barnsley, South Yorkshire. The practice offers dental treatment to patients on an NHS or privately funded basis. The services include preventative advice and treatment, routine restorative dental care and dental implants.

The practice has five surgeries, a decontamination room, a waiting area and a reception area. The reception area, waiting area and two surgeries are on the ground floor. The other three surgeries and the decontamination room are on the first floor. There are staff facilities on the second floor.

There are two principal dentists, three associate dentists, one dental hygienist, six dental nurses (two of whom are trainees) and a domestic cleaner. The dental nurses also cover reception duties.

The opening hours are Monday to Friday from 9-00am to 5-30pm.

One of the principal dentists is registered with the Care Quality Commission (CQC) as an individual. 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.

During the inspection we received feedback from 34 patients. The patients were positive about the care and treatment they received at the practice. Comments included staff were friendly, pleasant and efficient. They also commented that the dentists discuss treatment options very well and the practice is clean and hygienic.

Our key findings were:

  • The practice was visibly clean and uncluttered.
  • Staff had been trained to deal with medical emergencies. Most items of emergency medicines and equipment were available. The registered provider immediately ordered the missing items.
  • Staff were qualified and had received training appropriate to their roles.
  • Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
  • Dental care records showed treatment was planned in line with current best practice guidelines.
  • Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
  • We observed patients were treated with kindness and respect by staff.
  • Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
  • Patients were able to make routine and emergency appointments when needed.
  • The practice was accessible for wheelchair users and those with limited mobility. However, a Disability Discrimination Act audit had not been carried out.
  • The governance systems were effective.
  • There were clearly defined leadership roles within the practice and staff told us they felt supported, appreciated and comfortable to raise concerns or make suggestions.

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

  • Review the security of prescription pads in the practice.
  • Review the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the 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.
  • Review its complaint handling procedures and establish a system for handling and responding to complaints by patients.
  • Review the practice responsibilities to meet the needs of people with a disability and the requirements of the Equality Act 2010 and ensure a Disability Discrimination Act (DDA) audit is undertaken for the premises.
Inspection areas

Safe

No action required

Updated 8 March 2017

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

Staff told us they felt confident about reporting incidents and accidents. There was an effective system for the analysis of such events and they were discussed at practice meetings.

Staff had received training in safeguarding at the appropriate level and knew the signs of abuse and who to report them to.

Staff were suitably qualified for their roles and the practice had undertaken the relevant recruitment checks to ensure patient safety.

Staff were trained to deal with medical emergencies. The practice had most emergency medicines and equipment available, including an automated external defibrillator. The registered provider immediately ordered three items of equipment which were not available on the day of the inspection.

The decontamination procedures were effective and the equipment involved in the decontamination process was regularly serviced, validated and checked to ensure it was safe to use.

Prescriptions pads were not stored securely at night. We were told these would now be locked away to ensure their security.

A legionella risk assessment had recently been completed but this was not available on the day of inspection. We were later sent evidence that the building had been deemed low risk and a process to monitor hot and cold water temperatures had been implemented.

Effective

No action required

Updated 8 March 2017

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

Patients’ dental care records provided comprehensive information about their current dental needs and past treatment. The practice monitored any changes to the patient’s oral health and provided treatment when appropriate.

The practice followed best practice guidelines when delivering dental care. These included Faculty of General Dental Practice (FGDP), National Institute for Health and Care Excellence (NICE) and guidance from the British Society of Periodontology (BSP). The practice focused strongly on prevention and the dentists were aware of the ‘Delivering Better Oral Health’ toolkit (DBOH) with regards to fluoride application and oral hygiene advice.

Staff were encouraged to complete training relevant to their roles. The clinical staff were up to date with their continuing professional development (CPD).

Referrals were made to secondary care services if the treatment required was not provided by the practice.

Caring

No action required

Updated 8 March 2017

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

During the inspection we received feedback from 34 patients. The patients commented that staff were friendly, pleasant and efficient. They also commented that the dentists discuss treatment options very well.

We observed the staff to be welcoming and caring towards the patients.

We observed privacy and confidentiality were maintained for patients using the service on the day of the inspection.

Staff explained that enough time was allocated in order to ensure that the treatment and care was fully explained to patients in a way which they understood.

Responsive

No action required

Updated 8 March 2017

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

The practice had an efficient appointment system in place to respond to patients’ needs. There were vacant appointments slots for urgent or emergency appointments each day.

Two patients commented they felt they could not get an appointment in a timely manner. The practice manager was aware of this issue and told us they were currently recruiting a new dentist and had started to offer appointments on a Saturday.

There was a procedure in place for responding to patients’ complaints. This involved acknowledging, investigating and responding to individual complaints or concerns. Staff were familiar with the complaints procedure. We noted that one complaint from November 2016 had not been provided with a formal response yet. This was highlighted to the registered provider and we were assured this would be followed up.

The practice was accessible for wheelchair users and those with limited mobility. A DDA audit had not been carried out.

Well-led

No action required

Updated 8 March 2017

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

There was a clearly defined management structure in place and all staff felt supported and appreciated in their own particular roles. The registered provider was responsible for the day to day running of the practice.

Effective arrangements were in place to share information with staff by means of monthly practice meetings which were minuted for those staff unable to attend.

The practice regularly audited clinical and non-clinical areas as part of a system of continuous improvement and learning.

They conducted patient satisfaction surveys and were currently undertaking the NHS Friends and Family Test (FFT).