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Inspection Summary


Overall summary & rating

Updated 27 November 2018

We carried out this announced inspection on 25 October 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.

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

Toothcare Ltd is in Canvey Island in Essex, and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Four car parking spaces are available at the rear of practice.

The dental team includes one dentist, one dental nurse and one trainee dental nurse, one administrator, one receptionist and a practice manager. The practice has one treatment room and one decontamination room.

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. The registered manager at Toothcare Ltd is the principal dentist.

On the day of inspection, we collected 25 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with one dentist, one dental nurse, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5.30pm, and closes from 12.30pm to 2pm daily. The practice is open until 7.30pm on Tuesday evenings.

Our key findings were:

  • The practice appeared clean and well maintained.
  • The practice staff had infection control procedures which reflected published guidance. We found some pouched clean instruments had dental cement still on them. We discussed this with the provider who confirmed these instruments would be re-sterilised following our inspection.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • The practice had some systems to help them manage risk. We found there was no evidence that some actions recommended from the Legionella risk assessment had been completed.
  • The practice staff had mostly suitable safeguarding processes. Staff demonstrated awareness of their responsibilities for safeguarding adults and children. We found that contact information for safeguarding teams was out of date. Following the inspection, the practice confirmed these had been updated.
  • The practice had staff recruitment procedures; we found that some of these required strengthening.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • The appointment system met patients’ needs.
  • Staff felt involved and supported and worked well as a team.
  • The practice asked staff and patients for feedback about the services they provided.
  • The practice staff dealt with complaints positively and efficiently.
  • The practice staff had suitable information governance arrangements.

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

  • Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice and review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
  • Review the practice’s recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
  • Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
  • Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.
  • Review the practice’s protocols for the use of rubber dams for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
  • Review the management of sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013
Inspection areas

Safe

No action required

Updated 27 November 2018

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

The practice had some 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. Some safeguarding contact information was out of date. Following the inspection, the practice provided confirmation to CQC to confirm that this had been updated.

Staff were qualified for their roles and the practice mostly completed essential recruitment checks. We found that evidence of staff photographic identity had not always obtained at the point of recruitment. However several members of staff had been with the practice for over 20 years.

Premises were clean and properly maintained. The practice followed national guidance for cleaning, sterilising and storing dental instruments. We found some pouched clean instruments had dental cement still on them. We discussed this with the dental nurse and the provider who confirmed these instruments would be re-sterilised following our inspection.

The dentist rarely used rubber dam when providing root canal treatment and not all X-rays were justified or reported on.

We found there was no evidence that some actions recommended from the Legionella risk assessment had been completed.

We looked at a sample of dental care records to confirm our findings and saw some dental care records lacked detail. Records were kept securely and complied with General Data Protection Regulation (GDPR) protection requirements.

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

Effective

No action required

Updated 27 November 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 gentle, professional and caring.

The dentists discussed treatment with patients so they could give informed consent, we found that this was not always detailed in patients’ dental care records. We found that staff awareness of the principles of the Mental Capacity Act 2005 required updating and staff discussions held to ensure understanding.

The practice had clear arrangements when patients needed to be referred to other dental or health care professionals.

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

Caring

No action required

Updated 27 November 2018

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

We received feedback about the practice from 27 people. Patients were positive about all aspects of the service the practice provided. They told us staff were professional, accommodating and efficient.

They said that they were given helpful, informative and honest explanations about dental treatment, and said their dentist listened to them. Patients commented that they made them feel at ease, especially when they were anxious about visiting the dentist.

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 27 November 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 patients’ different needs. This included providing facilities for disabled patients and families with children. This included providing level access and a patient toilet facility suitable for those with limited mobility. Whilst a hearing loop was not installed, staff told us how they had made efforts to accommodate the needs of those with sight and hearing problems. The practice had access to telephone interpreter services, however we were told there had been no demand for this service.

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 27 November 2018

We found that this practice was providing well-led care in accordance with the relevant regulations. We identified some areas that required strengthening to ensure a robust approach was always adopted in the delivery of the service. For example, improving recruitment processes and ensuring detailed dental record keeping.

The practice had arrangements to ensure the smooth running of the service. These included systems for the practice 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.

Some options for treatment were discussed, but there was little detail of discussions recorded. We noted that until recently, information such as social and dental history, basic periodontal examination, examination of the tempero-mandibular joint and soft tissue and extra-oral examination were not always documented in full. We discussed this with the dentist and on review of more recent patient dental records noted that there had been some recent improvements.

The practice 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.