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Flitwick High Street Dental Practice

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Updated 23 March 2018

We carried out this announced inspection on 31 January 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They provided some information which we took into account.

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 form the framework for the areas we look at during the inspection.

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

The practice is located in Flitwick, a rural town in Bedfordshire. It provides NHS and private treatment to patients of all ages. At the time of our inspection, the practice were accepting new NHS and private patients.

There is level access for people who use wheelchairs and pushchairs with the use of a portable ramp over a slight step. There are some car parking spaces available at the practice. The practice do not currently have designated parking spaces for blue badge holders. Other payable car parking facilities are also available within short walking distance of the practice.

The dental team includes seven dentists, three dental nurses, five trainee dental nurses, two hygienists, four receptionists and a practice manager.

The practice has four treatment rooms; two of these are on the ground floor. We were informed that plans were in place to refurbish parts of the practice.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of the inspection the practice did not have a registered manager in post. The newly appointed practice manager has applied to undertake the registered manager role.

On the day of inspection we collected 17 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with four dentists, two dental nurses, four trainee dental nurses, two receptionists, the practice manager, the compliance manager and the area manager.

We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Friday from 8am to 8pm. The practice has recently started opening on Saturday mornings from 8am to 12pm.

Our key findings were:

  • The practice objectives included the provision of a high quality and range of dental services to the whole community through a friendly and professional service.
  • Staff had been trained to deal with emergencies and equipment and appropriate medicines were readily available in accordance with current guidelines.
  • The practice appeared clean and well maintained.
  • The practice had infection control procedures which reflected current published guidance.
  • Staff were aware of their responsibilities for safeguarding adults and children living in vulnerable circumstances.
  • The practice had implemented processes for the reporting and investigating of incidents and accidents.
  • Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
  • The practice demonstrated awareness of most of the needs of the local population and took these into account when delivering the service.
  • Patients had access to routine treatment and urgent care when required.
  • Staff received training appropriate to their roles and were supported in their continued professional development (CPD) by the practice.
  • The practice dealt with complaints efficiently.
  • Whilst there were governance arrangements, we noted areas where these could be strengthened.

There were areas where the provider could make improvements. They should:

  • Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
  • Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff. This refers particularly to staff immunity to Hepatitis B and ensure that any appropriate action is taken once received.
  • Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and infection control are undertaken at regular intervals to help improve the quality of the service. The practice should also ensure that where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
  • Review the current performance review systems in place and have an effective process established for the on-going assessment and supervision of all staff.
  • Review its responsibilities to respond to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

Inspection areas

Safe

No action required

Updated 23 March 2018

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

The practice had systems and processes to provide safe care and treatment. They used learning from incidents and complaints to help them improve.

Staff received training in safeguarding and knew how to recognise the signs of abuse and how to report concerns.

We found that not all dentists used rubber dam; this was not in accordance with guidelines issued by the British Endodontic Society. The practice told us about action they were taking to strengthen processes.

Staff were qualified for their roles and the practice completed essential recruitment checks.

Premises were clean on the day of our inspection. Patient comments included that the practice would benefit from a refurbishment. We saw evidence that equipment was maintained although we noted that historic maintenance records were not always available.

The practice followed national guidance for cleaning, sterilising and storing dental instruments.

The practice had suitable arrangements for dealing with medical and other emergencies.

Effective

No action required

Updated 23 March 2018

We found that this practice was providing effective care in accordance with

the relevant regulations.

The dentists assessed patients’ needs and provided care and treatment in line with recognised guidance. Patients described the treatment they received as excellent, good and gentle. The dentists discussed treatment with patients so they could give informed consent and recorded this in their records.

The practice had arrangements when patients needed to be referred to other dental or health care professionals. We noted that the monitoring systems for referrals could be strengthened.

Staff received an induction. Two staff members who had been employed for over one year were overdue appraisals. The practice had produced a plan for all staff appraisals to take place.

Caring

No action required

Updated 23 March 2018

We found that this practice was providing caring services in accordance with

the relevant regulations.

We received feedback about the practice from 17 people. Patients were positive about all aspects of the service the practice provided. They told us staff were

helpful and welcoming.

They said that they were given informative explanations about dental treatment and said their dentist listened to them. Feedback provided in some CQC comment cards included that staff made patients feel at ease, especially when they were anxious about visiting the dentist. Comments also included that children received a positive experience.

We saw that staff protected patients’ privacy and were aware of the importance of confidentiality. Patients said staff treated them with dignity and respect.

Responsive

No action required

Updated 23 March 2018

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

The practice’s appointment system was efficient and met patients’ needs. Patients could get an appointment quickly if in pain.

Staff considered most patients’ different needs. This included providing facilities for disabled patients and families with children. The practice had access to interpreter services. They did not have a hearing loop installed.

The practice took patients views seriously. They valued compliments from patients and responded to concerns and complaints quickly and constructively.

Well-led

No action required

Updated 23 March 2018

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

The practice had policies, procedures and risk assessments to support the management of the service and to protect patients and staff. We identified where an improvement should be made and action was taken by the provider.

There were arrangements to monitor the quality of the service and make improvements as a result. We also noted there were some areas of improvement required in governance arrangements. This included ensuring documentation was retained and available when required, when management arrangements changed within the practice.

Changes in staffing and staff shortages had impacted upon the smooth running of the practice. We identified that staff morale had become affected as a result. The provider had recently appointed a new and experienced practice manager to the role.

The practice team kept complete patient dental care records which were clearly written or typed and stored securely.

The practice had some limited quality assurance processes to encourage learning and continuous improvement. The practice manager told us that audit systems would be strengthened and we were provided with documentary evidence to support this following our inspection taking place.

The practice asked for patient feedback to improve the service delivered.