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Inspection Summary


Overall summary & rating

Updated 27 November 2017

We carried out this announced inspection on 24 October 2017 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

Evesham Dental Health Team is located in Evesham and provides predominantly private treatment with a small NHS contract to patients of all ages.

The practice is situated in a converted residential building which has been extended to provide additional facilities for patients. The building is spread over three floors with an adjoining annexe and there is level access into the practice for people who use wheelchairs and pushchairs. The ground floor of the practice consists of a front reception with patient seating area, a back reception, two patient toilets, two dental treatment rooms, two stock rooms, a staff changing room and a staff kitchen. On the first floor there is an x-ray room, three hygiene treatment rooms, one dental treatment room, a consultation room, a patient toilet and a decontamination room for the cleaning, sterilising and packing of dental instruments. The second floor is not accessible to patients and contains a dental laboratory and additional storage. The adjoining annexe houses the practice management office and further staff changing facilities. The practice benefits from five car parking spaces in their dedicated car park, they have a reserved for disabled access sign that they use to ensure that patients requiring the larger car parking space have access.

The dental team includes three dentists, 11 dental nurses, two dental hygiene therapists, two dental hygienists, three care coordinators and a practice manager. The practice has six treatment rooms in total.

The practice is owned by the principal dentist and his wife who is the practice manager there 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 Evesham Dental Health Team is the practice manager.

On the day of inspection we collected 41 CQC comment cards filled in by patients and received 18 ‘share your experience’ contacts through the CQC database. This information gave us an extremely positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses, one dental hygiene therapist, one care coordinator 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: 8.30am – 7pm

Tuesday: 8.30am – 7pm

Wednesday: 8.30am – 7pm

Thursday: 8.30am – 7pm

Friday: 8.30am – 5.30pm

Three out of four Saturdays: 8am – 1pm

Our key findings were:

  • We noted that the practice ethos was to provide quality dental care in an environment that was supportive, friendly and relaxed.
  • Strong and effective leadership was provided by the principal dentist and empowered practice manager. Staff felt involved and supported and worked well as a team.
  • Staff had received training appropriate to their roles and were supported in their continued professional development by the principal dentist and practice manager.
  • The practice was clean and well maintained. Contracted cleaners were responsible for the day to day cleaning.
  • The practice had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • The practice had systems to help them manage risk. The practice had an established process for reporting and recording significant events and accidents to ensure they investigated these and took remedial action.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The practice 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.
  • The appointment system met patients’ needs. Patients could access treatment and urgent and emergency care when required.
  • The practice asked staff and patients for feedback about the services they provided. Information from 41 completed Care Quality Commission (CQC) comment cards and 18 ‘share your experience’ patient contacts on the CQC database gave us an extremely positive picture of a professional, friendly, caring and high quality service.
  • The practice dealt with complaints positively and efficiently.

We identified an area of notable practice.

  • The practice were dedicated to protecting patients from oral cancer and had purchased equipment that could identify abnormal cells often pertaining to oral cancer. All patients were screened using this equipment at every six monthly assessment appointment. If there was a change in the cells patients were then recalled for a retest at a set period of time and then referred to secondary care if appropriate. In addition to this the practice advertised in the local GP practices and pharmacies that this service was free for any local person who wished to be screened as a commitment to minimising late diagnosis of oral cancer in the local area and saving lives.

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

  • Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.
  • Review the use of risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities ensuring these are reviewed annually.
Inspection areas

Safe

No action required

Updated 27 November 2017

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. The practice had completed comprehensive general and health and safety risk assessments however, these were not reviewed on an annual basis to ensure that risks were continually being monitored and mitigated.

They used learning from incidents and complaints to help them improve. The learning from these were discussed at team ‘huddles’ and monthly staff meetings.

The practice held NHS and private prescriptions. The prescription details were documented in the patients clinical care records when issued and they were stored securely. We found that prescriptions were not recorded and logged centrally prior to being issued which prevented the practice from being able to track all prescriptions and audit them.

Staff received training in safeguarding and knew how to recognise the signs of abuse and how to report concerns. The principal dentist and practice manager were the safeguarding leads in the practice.

Staff were qualified for their roles and the practice completed essential recruitment checks. There were sufficient numbers of suitably qualified staff working at the practice.

Premises and equipment were clean and properly maintained. 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 27 November 2017

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 the best treatment ever, outstanding, painless and highly professional. The dentists discussed treatment with patients so they could give informed consent and recorded this in their records.

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

The practice were highly committed to providing extensive preventative oral hygiene advice and support. They routinely referred patients to their dental hygienists and dental hygiene therapists through a clear care pathway. All patients received extensive oral hygiene instruction before any treatment and were given a card with their basic periodontal examination scores and further advice to use between appointments. The practice highlighted the dangers of bacteria found in plaque by removing a small amount of plaque from the patient’s mouth and placing this under a microscope so that this could be viewed on the monitor in the consultation room. This increased patient understanding of gum disease and demonstrated the importance of good oral hygiene.

The practice supported staff to engage with local charities and gave staff paid time off to visit a diverse range of local community groups providing preventive oral hygiene advice. Some of the practice nurses visited local schools to educate children in tooth brushing techniques and deliver healthy eating advice. In addition to this, one of the dental hygiene therapists also visited local care and residential homes meeting with the carers and nurses and delivering oral health advice to enhance their learning and better support residents.

The practice were dedicated to protecting patients from oral cancer and had purchased equipment that could identify abnormal cells often pertaining to oral cancer. All patients were screened using this equipment at every six monthly assessment appointment. If there was a change in the cells patients were then recalled for a retest at a set period of time and then referred to secondary care if appropriate. In addition to this the practice advertised in the local GP practices and pharmacies that this service was free for any local person who wished to be screened as a commitment to minimising late diagnosis of oral cancer in the local area and saving lives.

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

Every patient was allocated a dedicated nurse that supported them throughout the course of their treatment. Most of the dental nurses had extended duties which included impression taking, topical fluoride application, radiography and oral health instruction to enhance patient support.

Caring

No action required

Updated 27 November 2017

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

the relevant regulations.

We received feedback about the practice from 59 people. Patients were extremely positive about all aspects of the service the practice provided. They told us staff were very helpful, excellent, first class and more like friends than providers of a service. They said that they were given very knowledgeable advice, care is always taken to reassure and relax patients and said the team were attentive and listened to them. Patients commented that they made them feel at ease, especially when they were anxious about visiting the dentist.

The practice care coordinators were on hand to discuss patient needs at length and ensure any reasonable adjustments were made for patients visiting the practice including reserving disabled car parking if required. The care coordinators also made after care calls to patients following treatment to ensure that they happy, offer any further advice and discuss any concerns they may have.

We saw that staff protected patients’ privacy and were aware of the importance of confidentiality. Patients said staff always treated them with the utmost dignity and respect and that nothing was too much trouble.

Responsive

No action required

Updated 27 November 2017

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. The practice offered extended hours appointments opening early Monday to Friday from 8.30am and late Monday to Thursday until 7pm. Saturday morning appointments were also available for patients preferring not to attend during the week.

Staff considered patients’ different needs. This included providing facilities for disabled patients and families with children. The practice had access to telephone interpreter services and had arrangements to help patients with sight or hearing loss.

The practice had been accredited by Dental Phobia UK who hold the practice details and supporting testimonials on their website as they were deemed experts with a great deal of experience of supporting phobic patients or people who were simply frightened of the dentist or the dental experience. The practice had many techniques available to support and rebuild phobic patient’s confidence including immersive sensory experiences, sedation, hypnotherapy techniques and homeopathic approaches. The dental nurses and care coordinators worked very closely with the dentists to ensure every patient need was met.

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 2017

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

Strong and effective leadership was provided by the principal dentist and an empowered practice manager. The principal dentist, practice manager and other staff had an open approach to their work and shared a commitment to continually improving the service they provided. There was a no blame culture in the practice. Staff told us that they felt well supported and could raise any concerns with the principal dentist and practice manager. All the staff we met said that they were happy in their work and the practice was a good place to work.

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.

The practice was a British Dental Association (BDA) good practice member, a quality assurance programme that allows its members to communicate to patients an on-going commitment to working to standards of good practice on professional and legal responsibilities. Evesham Dental Health Team was highly commended in recognition of outstanding standards of patient care in the Independent Dentistry ‘Practice of the Year Award’.

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

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. We saw that 100% of the patients who responded to the friends and family test survey in September 2017 were extremely likely to recommend the practice to a friend or family member. The results from the practice satisfaction survey, suggestions box and comments book were also extremely positive.