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Warrington House Dental Practice

Inspection Summary


Overall summary & rating

Updated 26 September 2016

We carried out an announced comprehensive inspection on 26 July 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

Warrington House Dental Practice is located in Brislington, a residential area of Bristol, and provides NHS and private treatment to patients of all ages. The practice consists of three treatment rooms, toilet facilities for patients and staff, a reception/ waiting area and a staff room.

The practice treats both adults and children. The practice offers routine examinations and treatment. There are five dentists.

The practice’s opening hours are

8.00 to 17.00 on Monday

8.00 to 19.00 on Tuesday

8.00 to 17.45 on Wednesday

8.00 to 17.30 on Thursday

8.45 to 15.00 on Friday

The dentists operate an on-call system out of hours.

We carried out an announced, comprehensive inspection on 26 July 2016. The inspection was led by a CQC inspector accompanied by a dental specialist advisor.

Before the inspection we looked at the NHS Choices website but there were no reviews.

For this inspection 36 people provided feedback to us about the service. Patients were positive about the care they received from the practice. They were complimentary about the service offered which they said was good or excellent. They told us that staff were professional, efficient, helpful, polite, caring and friendly and the practice was clean and hygienic. We received one negative comment about the reception staff sometimes being abrupt.

Our key findings were:

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

• When recruiting staff the relevant checks were completed but not within timescales identified in current guidance. Staff received relevant training.

• The practice had ensured that risk assessments were in place and that 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 patients’ clinical details were updated.

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

• 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.

• All feedback that we received from patients was positive; they reported that it was a professional, helpful, caring and friendly service.

• There were arrangements for governance 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 recruitment procedures to ensure Disclosure and Barring checks and two written references are obtained before new staff start work in the practice.

  • Review the training for medical emergencies to include role play to give staff the opportunity to learn how to work together in the event of an emergency.

  • Review the process for checking the fire safety measures to include routine checks to ensure all the safety measures are working properly.

  • Review the arrangements for checking the fridge temperatures to make sure they are kept at the correct level for the storage of medicines.

  • Review the arrangements for keeping prescriptions to introduce a process of checking to ensure none are missing.

  • Review the procedure for taking X-rays so that they are always graded to assess the quality.

  • Review the training and development for dentists about the Mental Capacity Act 2005 and capacity and consent so that all dentists understand about adults’ and children’s capacity to consent.
Inspection areas

Safe

No action required

Updated 26 September 2016

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

There were appropriate systems for reporting incidents and for learning from incidents. Staff had received training about safeguarding adults and children. There were policies about safeguarding and whistleblowing and staff knew how to report any concerns.

There were also arrangements for dealing with foreseeable emergencies, for fire safety and for managing risks to patients and to staff. However, routine checking of the fire safety measures was not taking place. There was a business continuity plan. Hazardous substances were managed safely.

Most of the appropriate checks were being made to make sure staff were suitable to work with vulnerable people. However, references and Disclosure and Barring checks were not always obtained before staff started to work in the practice. The necessary medicines were in place. Equipment was regularly serviced. X-rays were dealt with safely.

The surgeries were fresh and clean and guidance about decontamination of instruments was being followed to reduce the risk of the spread of infection. 

Effective

No action required

Updated 26 September 2016

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

The dentists took X-rays at appropriate intervals. The practice checked the condition of the gums for every patient and they checked for signs of oral cancers. Patients completed medical history questionnaires and these were updated at each visit. The practice kept up to date with current guidelines and research. They promoted the maintenance of good oral health through information about effective tooth brushing. The dentists discussed health promotion with individual patients according to their needs.

The practice had sufficient staff to support the dentists. Staff received appropriate professional development and all of the expected training.

The practice had suitable arrangements for working with other health professionals and making appropriate referrals to ensure quality of care for their patients. Patients were asked for consent to treatment. Patients told us that the dentists discussed options for treatment with them. The patient notes showed that options for treatment were discussed to help patients to make decisions about their care.

Some of the dentists showed understanding about the Mental Capacity Act 2005 (MCA) and what they would do if an adult lacked the capacity to make particular decisions for themselves. They also understood that some children were competent to be involved in decision making and consent to treatment.

Caring

No action required

Updated 26 September 2016

We found that this practice

was providing caring services in accordance with the relevant regulations.

Staff in the

practice were polite and respectful when speaking to patients. Patients’

privacy was respected and treatment room doors were closed during

consultations. The practice used an electronic record system and the computer

screens in reception were shielded so that they could not be seen by patients.

 

Patients were positive about the care they received from the practice.

They reported that staff were

professional, helpful, caring and friendly

. The

dentists discussed different treatment options with patients to help them to

decide on the best treatment for them. 

Responsive

No action required

Updated 26 September 2016

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

The practice had a system to schedule enough time to assess and meet patients’ needs. Patients said that they could get an appointment easily. Emergencies were usually fitted in on the day the patient contacted the practice. The practice actively sought feedback from patients on the care being delivered. There was a procedure about how to make a complaint and the process for investigation. We saw evidence that the practice responded to feedback made direct to the practice and made changes when necessary.

There was an equality and diversity policy and staff had received training about equality and diversity. The dentists spoke different languages and one of the nurses had knowledge of British sign language. There was information about translation services for people whose first language was not English. There was level access for wheelchair users to one of the surgeries. There was a hearing loop system for patients who had a hearing impairment. 

Well-led

No action required

Updated 26 September 2016

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

The practice had set up systems for clinical governance such as audits of the infection control, record keeping and radiographs. There were checks of equipment. The autoclave and compressor were serviced and there were daily checks of the autoclave.

The practice had a range of policies which were made available to staff.

The practice manager and the provider were the lead professionals for the practice. There was a whistleblowing policy and information for staff about the duty of candour and the need to be open if an incident occurred where a patient suffered harm. So far there had been no such incidents.

The practice manager and the provider held team meetings. Staff were responsible for their own continuing professional development and kept this up to date.

The practice was sought feedback from patients through patient satisfaction feedback forms. They analysed these and made improvements in response to the feedback.