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Hadleigh Road Family Dental Practice

Inspection Summary


Overall summary & rating

Updated 13 September 2016

We carried out an announced comprehensive inspection on 15 July 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

Hadleigh Road Family Dental Practice is a dental practice situated in a converted house in Leigh on Sea, Essex.

The practice has two treatment rooms, a combined waiting and reception area. Decontamination takes place in a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

The practice has a principal dentist and one qualified dental nurse and two receptionists. Two part time hygienists are also employed at the practice.

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.

The practice offers general and cosmetic NHS dental treatments to adults and children.

The practice is open and offers appointments between 8.30 am and 12 noon and between 2.30 pm 4.30 pm on Mondays, Thursdays and Fridays and between 8.30 am and 12 noon on Wednesdays. Evening appointments were available up to 6.30 pm on Tuesdays.

We left comment cards at the practice for the two weeks preceding the inspection. 46 people provided feedback about the service in this way. All of the comments spoke highly of the dental care and treatment that they received and the professional, attentive and caring attitude of the dentist and the dental nurse.

Our key findings were:

  • There was an effective complaints system and learning from complaints was used to make improvements where this was required.
  • The practice was visibly clean and clutter free and Infection control practices met national guidance.
  • There were a number of systems in place to help keep people safe, including safeguarding vulnerable children and adults.
  • Dental care and treatments were carried out in line with current legislation and guidelines.
  • Patients reported that they were treated with respect and dignity, professional care and compassion and staff were understanding, polite and helpful.
  • Patients were involved in making decisions about their care and treatments.
  • The practice provided a flexible appointments system and could normally arrange a routine appointment within a few days or emergency appointments mostly on the same day.
  • The practice kept medicines and equipment for use in medical emergencies. These were in line with national guidance and regularly checked so that they were fit for use.
  • There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
  • Governance arrangements were in place for the smooth running of the service.
  • Patient’s views were sought and used to make improvements to the service where these were identified.

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

  • Review the procedures for carrying out root canal treatments taking into account the use of a rubber dam in line with guidance issued by the British Endodontic Society.
  • Review the arrangements for monitoring the quality of records and implement a system for regular audits in respect of patient records in line with the Royal College of Surgeons - Faculty of General Dental Practice (FGDP) guidance.
  • Review the arrangements checking emergency medicines and for storing temperature sensitive medicines and keep records of fridge temperatures to ensure that these are appropriate.
  • Review the arrangements in place for monitoring and mitigating the risks associated with legionella and keep records of hot and cold water temperatures.
  • Review the arrangements for reporting on X-rays and record the justification for X-rays in accordance with the National Radiological Protection Board (NRPB) guidelines.
  • Review the arrangements for supporting patients who have a physical disability or impairment and consider making any reasonable adjustments in line with the Equality Act 2010.
Inspection areas

Safe

No action required

Updated 13 September 2016

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

The practice had effective systems and processes in place to provide safe care and treatment and to assess and minimise risks. There were a range of risk assessments in place including fire safety, health and safety and legionella. These were reviewed regularly and appropriate action taken as needed to help keep people safe. However records audits were not carried out routinely to help demonstrate that all of the appropriate information in relation to the safe delivery of patient care and treatment was recorded including the justification (reason for) X-rays.

The practice had procedures in place to safeguard children and vulnerable adults. The dentist and staff had undertaken training appropriate to their role, and understood their responsibilities in this area.

The practice was visibly clean and infection control procedures were in line with national guidance.

The cleaning and decontamination of dental instruments was carried out in line with current guidelines.

Equipment within the practice was regularly checked, serviced and maintained according to the manufacturer’s instructions.

The practice had a range of equipment and medicines for use in medical emergencies and these were in line with national guidance. Staff had undertaken appropriate training. Medicines and equipment available and accessible to staff. However records in respect of checks for emergency medicines and equipment were not maintained such as checking the expiry dates for medicines and fridge temperatures were not monitored and recorded.

The practice had an appropriate recruitment policy and procedure in place. No new staff had been employed within the previous 10 years.

Effective

No action required

Updated 13 September 2016

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

Consultations were carried out in line with good practice guidance from the National Institute for Health and Care Excellence (NICE). On joining the practice, patients underwent an assessment of their oral health and were asked to provide a medical history. This information was regularly reviewed and used to plan patient care and treatment. Patients were recalled after an agreed interval for an oral health review, during which their medical histories and examinations were updated and any changes in risk factors recorded.

Patients were offered options of treatments available and were advised of the associated risks and intended benefits. Patients were provided with appropriate information which detailed the treatments considered and agreed together and the fees involved. Patients’ consent was obtained before their treatment commenced.

Patients were referred to other specialist services where appropriate and in a timely manner.

The principal dentist and the dental nurse were registered with the General Dental Council (GDC) and maintained their registration by completing the required number of hours of continuing professional development activities.

Caring

No action required

Updated 13 September 2016

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

The practice had procedures in place for respecting patients’ privacy, dignity and providing compassionate care and treatment. A private room was available should patients wish to speak confidentiality with the dentist or reception staff. Staff had access to policies and procedures in relation to respecting and promoting equality and diversity.

Each of the three patients we spoke with said that they were treated with respect and kindness by staff. Comments on the 46 completed CQC comment cards we received also reflected patients high levels of satisfaction with how they were treated by staff. Patients indicated that staff treated them with care and kindness. They said that staff were professional, understanding and sensitive particularly when patients were experiencing pain or anxiety.

Patients said that they were able to be involved in making decisions about their dental care and treatment. Comments on the 46 completed CQC comment cards we received included statements by patients saying they were involved in all aspects of their care. They said that they were allocated enough time and that treatments were explained in a way that they could understand, which assisted them in making informed decisions.

Responsive

No action required

Updated 13 September 2016

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

Patients could access routine treatment and urgent care when required. Appointments could be booked in person, online or by telephone. The practice operated a triage system to help identify and prioritise urgent same day access for patients experiencing dental pain which enabled them to receive treatment quickly.

Patients we spoke with told us that the dentist offered a flexible service and one patient gave an example of receiving emergency dental treatment within a few hours of contacting the practice.

The practice was open and offered appointments between The practice was open and offered appointments between 8.30 am and 12 noon and between 2.30 pm 4.30 pm on Mondays, Thursdays and Fridays and between 8.30 am and 12 noon on Wednesdays. Evening appointments were available up to 6.30 pm on Tuesdays. Patients were provided with information about accessing emergency dental treatment when the practice was closed.

The practice premises were accessible. Staff told us that they did not have access to language translation services if these were required. They told us that all patients were English speaking and that they would review this should translation services be required. The practice did not have a hearing loop system to assist patients who use a hearing aid or those with impaired hearing and no assessment had been undertaken to determine if these were required.

The practice had a complaints process which was available to support any patients who wished to make a complaint. The process described the timescales involved for responding to a complaint and who was responsible in the practice for managing them.

Well-led

No action required

Updated 13 September 2016

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

The practice team was small consisting of one dentist two dental nurses, a receptionist and two part time dental hygienists. Staff told us that they worked well as a team and they were clear about their roles and responsibilities to ensure the smooth running of the service. Regular practice meetings were held during which relevant information was shared and discussed.

The practice carried out some audits to monitor its performance and help improve the services offered. For example, risk assessments in relation to fire safety, infection control and legionella and these were regularly reviewed.

However X-ray audits which are mandatory, clinical examinations and patients’ dental care records audits were not regularly carried out and checks in relation to monitoring medicines were not robust.

The principal dentist ensured that appropriate training was accessible and that learning and development needs of staff was reviewed at appropriate intervals through a process of assessment, appraisal and supervision.

The practice regularly sought and acted on feedback from patients in order to improve the quality of the service provided.