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Inspection Summary


Overall summary & rating

Updated 6 August 2019

We carried out this announced inspection on 11 June 2019 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.

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.

Background

HMP Whatton is a Category C training prison in Nottinghamshire holding 838 convicted male prisoners. It fulfils a national function to provide services that seek to address the offending behaviour of men mainly convicted of sexual offences. More than 90 per cent of Whatton’s population are serving sentences in excess of four years, with just under three-quarters of these serving indeterminate or life sentences. Prisoners held at HMP Whatton come from across the country, and about two-thirds are aged over 40. The prison is operated by Her Majesty’s Prison and Probation Service.

Time for Teeth Limited is sub-contracted by the primary healthcare provider at the prison, to provide dental services to men held at the prison. Time for Teeth Limited is registered with the CQC to provide the following regulated activities at this location: Treatment of disease, disorder or injury, Diagnostic and screening procedures, and Surgical procedures.

CQC has not previously inspected this location. It was last inspected by Her Majesty’s Inspectorate of Prisons (HMIP) in August 2016. The HMIP inspection report can be found at: https://www.justiceinspectorates.gov.uk/hmiprisons/wp-content/uploads/sites/4/2016/12/HMP-Whatton-Web-2016.pdf

The dental team includes a dentist, dental nurse and dental therapist. The service has one treatment room. Four dentist sessions are run over two days every week, and two therapist sessions are run on one day a week. The dental nurse is on site Monday to Friday. The dental suite was located in the main healthcare department, which was on the ground floor of a building accessible to patients with mobility issues.

During the inspection we spoke with the clinical team, the location’s compliance lead, and Time for Teeth Limited’s clinical lead. We looked at policies and procedures and other records about how the service is managed. We also spoke with four patients.

Our key findings were:

  • The facilities appeared clean and well maintained.
  • The provider had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • The service had systems to help them manage risk to patients and staff.
  • The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults.
  • The provider had thorough staff recruitment procedures.
  • The clinical staff provided patients’ care and treatment in line with current guidelines.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • Staff were providing preventive care and supporting patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider had effective leadership and culture of continuous improvement.
  • Staff felt involved and supported and worked well as a team.
  • The provider asked staff and patients for feedback about the services they provided.
  • The provider dealt with complaints positively and efficiently.
  • The provider had suitable information governance arrangements.

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

  • Work with the main healthcare provider to establish formal monitoring arrangements to ensure effective oversight of infection control, equipment maintenance, patient access and complaints.
  • Undertake a specific sharps risk assessment, to be updated annually.
  • Consider adjusting the timetabling of dentist sessions to ensure that patients requiring urgent treatment could be seen by a dentist more promptly.
Inspection areas

Safe

Updated 6 August 2019

The service 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 people and knew how to recognise the signs of abuse and how to report concerns.

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

Premises and equipment were clean and properly maintained. The service followed national guidance for cleaning, sterilising and storing dental instruments.

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

Effective

Updated 6 August 2019

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

The service had clear arrangements when patients needed to be referred to other dental or health care professionals or was transferred to another prison.

The provider supported staff to complete training relevant to their roles and had systems to help them monitor this.


Caring

Updated 6 August 2019

We spoke to four patients. They were positive about all aspects of the service provided.

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

Updated 6 August 2019

The service’s appointment system took account of patients’ needs. Patients were prioritised if in pain or displaying facial swelling. However, the current scheduling of dental sessions on two consecutive weekdays meant that patients could wait up to six days to be seen by a dentist at the next session for full treatment. Pain, infection and emergency treatment needs were managed by the main healthcare provider when the dentist was off site,

Staff considered patients’ different needs. The service worked with the prison’s main healthcare provider to access telephone interpreter services and arrangements to help patients with a disability, including sight or hearing loss.

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

Well-led

Updated 6 August 2019

The provider had arrangements to ensure the smooth running of the service. These included systems for the clinical team to discuss the quality and safety of the care and treatment provided. There was a clearly defined management structure and staff felt supported and appreciated.

The team kept complete patient dental care records, using Time for Teeth Limited templates following Faculty of General Dental Practice (FGDP) guidance, which were clearly typed and stored securely.The provider monitored clinical and non-clinical areas of their work to help them improve and learn. This included asking for and listening to the views of patients and staff.

However, Time for Teeth Limited did not have arrangements in place with the main healthcare provider

to ensure effective oversight of

shared processes.