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Inspection Summary


Overall summary & rating

Updated 6 February 2017

We carried out an announced comprehensive inspection on 25 October 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

The Station Dental Practice has three dentists who work full time, three qualified dental nurses who are registered with the General Dental Council (GDC), two trainee dental nurses, a practice manager and a receptionist. The practice’s opening hours are 9am to 5.30pm on Monday to Friday.

The Station Dental Practice provides NHS and private dental treatment for adults and children. The practice has three dental treatment rooms on the ground floor. There is a separate decontamination room for cleaning, sterilising and packing dental instruments. There is also a reception and waiting area.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received feedback from 10 patients who provided a positive view of the services the practice provides. All of the patients commented that the quality of care was good.

Our key findings were

  • Systems in place for the recording and learning from significant events and accidents were not robust.
  • There were sufficient numbers of suitably qualified staff to meet the needs of patients.
  • Patients were treated with dignity and respect.
  • Rubber dam kits had recently been made available and although these had not been previously used by the dentist we were told that these would be used in the future.
  • The practice was visibly clean and well maintained.
  • The practice was not completing all pre-employment checks such as pre-employment medical questionnaires.
  • Infection prevention and control audits had not been undertaken on a six monthly basis, the date of the last audit was February 2016. Following this inspection we were forwarded a copy of an audit completed on 26 October 2016.
  • Not all issues identified in the practice’s fire risk assessment had been addressed.
  • There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
  • The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
  • Staff had been trained to deal with medical emergencies.
  • The appointment system met the needs of patients and waiting times were kept to a minimum.
  • Patient care records did not all record information regarding discussions held about treatment options and any risks of treatment. There were no leaflets available to provide information to patients about dental treatments or oral health.
  • The practice did not have robust systems in place to monitor quality, at the time of inspection there had been no X-ray audit or record card audit within the last 18 months. The practice was not completing patient satisfaction surveys apart from the NHS Friends and Family Test. The practice manager forwarded a copy of an X-ray audit following this inspection.

There were areas where the provider could make improvements and should:

  • Review the practice’s safety systems to include the implementation of a robust system for the recording and reviewing of accidents or significant events and provide evidence of action taken to prevent further occurrences or ensure that improvements are made as a result.
  • Review systems and processes in place at the practice to protect patients undergoing root canal treatment.
  • Review the security of prescription pads in the practice.
  • Review the recruitment procedures and protocols to ensure that all pre-employment information is obtained in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

  • Review the practice’s fire safety procedures and ensure that issues identified in the practice’s fire risk assessment have been addressed.
  • Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
  • Review the practice’s protocols for completion of clinical audit to include a review of the frequency of audits such as radiography, record card and infection prevention and control audits.
Inspection areas

Safe

No action required

Updated 6 February 2017

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

Systems in place for recording significant events and accidents were not robust. There were no significant event records or policy and an event at the practice had not been recorded as a significant event. Accident records contained brief information with no recorded evidence of action taken or outcome.

Equipment in use at the practice had been serviced and validated in line with manufacturer’s guidance.

Medicines for use in an emergency were available on the premises as detailed in the Guidance on Emergency Medicines set out in the British National Formulary (BNF). Emergency medical equipment was also available and documentation was available to demonstrate that checks were being made to ensure equipment was in good working order and medicines were within their expiry date. Staff had received training in responding to a medical emergency.

There were sufficient numbers of suitably qualified staff working at the practice. Staff had received safeguarding training and were aware of their responsibilities regarding safeguarding children and vulnerable adults.

Infection control audits were not being undertaken on a six monthly basis in line with the recommendations of HTM 01-05. The practice manager forwarded a copy of an infection control audit completed the day following our inspection and we were given assurances that these audits would now be completed on a six monthly basis.

The practice had systems in place for waste disposal and on the day of inspection the practice was visibly clean and clutter free.

Effective

No action required

Updated 6 February 2017

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

The practice used current national professional guidance including that from the National Institute for Health and Care Excellence (NICE) to guide their practice. There were clear procedures for referring patients to secondary care (hospital or other dental professionals). Referrals were made in a timely way to ensure patients’ oral health did not suffer.

Staff were appropriately registered in their roles, and had access to ongoing training and support.

The practice used oral screening tools to identify oral disease. Patients and staff told us that explanations about treatment options and oral health were given to patients in a way they understood and risks, benefits, options and costs were explained although patient care records that we were shown did not demonstrate this.

Caring

No action required

Updated 6 February 2017

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

We observed privacy and confidentiality were maintained for patients using the service on the day of the inspection. Staff treated patients with kindness and respect and were aware of the importance of confidentiality. Feedback from patients was overwhelmingly positive. Patients praised the staff and the service and treatment received. Patients commented that staff were professional, friendly and helpful.

Responsive

No action required

Updated 6 February 2017

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

Patients had good access to treatment and urgent care when required. The practice had ground floor treatment rooms and a toilet which had been adapted to meet the needs of patients with a disability. Ramped access was provided into the building for patients with mobility difficulties and families with prams and pushchairs.

The practice had developed a complaints procedure and information about how to make a complaint was available for patients to reference.

Well-led

No action required

Updated 6 February 2017

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

There was an effective management structure in place. Regular staff meetings were held and systems were in place to ensure all staff who were unable to attend the meeting received an update about topics of discussion. Staff said that they felt well supported and could raise any issues or concerns with the registered manager.

Annual appraisal meetings took place and staff said that they were encouraged to undertake training to maintain their professional development skills. However the practice did not have effective risk management structures in place. For example systems in place for recording and learning from significant events and accidents were not robust. The practice had not recorded one event to the Care Quality Commission or recorded this as a significant event.

The practice were not completing infection prevention and control audits on a six monthly basis and not all of the issues in the fire risk assessment had been addressed. The practice did not have robust systems in place to monitor quality; at the time of inspection there had been no X-ray audit or record card audit within the last 18 months. The practice was not completing patient satisfaction surveys apart from the NHS Friends and Family Test. The practice manager forwarded a copy of an X-ray and an infection control audit following this inspection.