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Chrysalis Dental Practice - Bedford

Inspection Summary


Overall summary & rating

Updated 11 December 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

Chrysalis Dental Practice is in Bedford, the county town of Bedfordshire and provides NHS and private treatment to adults and children. The practice provides general dentistry, implants, oral surgery and cosmetic procedures.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one allocated for blue badge holders, are available in the practice’s car park at the rear of the premises.

The dental team includes seven dentists, two oral surgeons, five dental nurses, two trainee dental nurses, one decontamination assistant, two dental hygienists, two receptionists and a practice manager. The practice has five treatment rooms; one of which is located on the first floor.

The practice is an approved training practice for dentists new to general dental practice. The principal dentist is a trainer.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 41 CQC comment cards filled in by patients.

During the inspection we spoke with four dentists (Including the principal), one trainee dental nurse, the decontamination assistant, two receptionists and the practice manager. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5pm. On Saturdays the practice opens only for oral surgery.

Our key findings were:

  • The practice 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 practice had systems to help them manage risk to patients and staff.
  • The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • 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.
  • The provider was providing preventive care and supporting patients to ensure better oral health.
  • The practice was responsive to the needs of the population and provided dental care and treatment for anyone who attended the local hospital Accident and Emergency department.
  • The appointment system met patients’ needs. Patients with a dental emergency were seen on the same day.
  • The practice had highly effective leadership and culture of continuous improvement.
  • 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 provider dealt with complaints positively and efficiently.
  • The provider had suitable information governance arrangements.
  • A culture of staff postgraduate education and qualifications was embedded within the practice.

We identified areas of notable practice.

There was a strong embedded culture of professional development for all clinical staff. The principal dentist had been a trainer for trainee dentists for 21 years. We were provided with many very positive examples of staff who had excelled in their professional careers as a result of training, supervision and support provided by the principal dentist. For example, a previous trainee dentist had been accepted into a prestigious overseas dental school to undertake an advanced endodontics degree. The dentist had plans to return to work in the practice once this was completed. Another former trainee dentist was at the time of our inspection, training to become a maxillo facial surgeon and another worked as a consultant orthodontist in a hospital trust. Four dental nurses who had worked in the practice had acquired qualifications to become hygienists. Two dental nurses were currently working at the practice and were completing their hygienist qualification. The decontamination nurse and cross infection lead had attended a Masters degree in Dental Public Health and was currently undertaking their Licence in Dental Surgery (LDS). Staff praised the principal dentist for his ongoing support, dedication and encouragement for them to achieve their aspirations. This had a positive outcome for patients (and the wider NHS) who benefitted from the adopted approach.

The practice was responsive to the needs of the local population. The local hospital Accident and Emergency Department signposted people who attended the hospital with urgent dental care needs, to the practice. We were told that patients had been signposted to the practice by the hospital for approximately five years and around 250 people had been treated as a result. The practice told us this had had the benefit of relieving pressure from the hospital.

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

  • Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
  • Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken for products used for general cleaning purposes.

Inspection areas

Safe

No action required

Updated 11 December 2018

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. They had systems to learn from incidents if they occurred. We found that the systems for recording the outcomes from accidents required some review.

Staff received both formalised and in-house 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 practice completed essential recruitment checks.

Premises and equipment were clean and properly maintained. The practice followed national guidance for cleaning, sterilising and storing dental instruments. Infection control processes were regularly discussed in practice meetings to ensure best practice was always followed by staff.

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

Effective

No action required

Updated 11 December 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 excellent, impeccable and delivered by professionals. 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.

Clinical staff undertook visits to local care homes to provide oral health care for residents who experienced difficulty in accessing the practice.

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

Dental nurses had been given a two-year professional development plan and dentists had a five-year plan. This was monitored by the principal dentist.

A culture of staff postgraduate education and qualifications was embedded within the practice.

The staff were involved in quality improvement initiatives including peer review as

part of their approach in providing high quality care

. We were provided with examples that included post graduate qualification study groups.

Caring

No action required

Updated 11 December 2018

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

the relevant regulations.

We received feedback about the practice from 41 people. Patients were positive about all aspects of the service the practice provided. They told us staff were

polite, understanding and considerate.

We noted a number of complimentary comments that referred to individual dentists.

Patients said that they were given helpful, informative 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 looked at feedback left on the NHS Choices website. We noted that all reviews left were very positive and the practice was rated as five out of five stars. Comments included that staff had gone above and beyond to treat an emergency case in their own time, and that a patient now looked forward to visiting their 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 11 December 2018

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

The practice was responsive to the needs of the local population. The local hospital Accident and Emergency Department signposted people who attended the hospital with urgent dental care needs, to the practice. We were told that patients had been signposted to the practice by the hospital for approximately five years and around 250 people had been treated as a result. The practice told us this had had the benefit of relieving pressure from the hospital.

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. The practice had access to interpreter services and had arrangements to help patients with hearing loss.

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 11 December 2018

We found that this practice was providing well-led care in accordance with

the relevant regulations.

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.

We were provided with many examples of how trainee dentists who had started their career in the practice had been supported by the principal dentist to continue with their academic studies. For example, a former trainee dentist had become the first dentist in five years to be accepted into a prestigious overseas dental school to undertake an advanced endodontics degree. The dentist had plans to return to work in the practice once this was completed.

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.

The principal dentist had implemented in-house training programmes for staff. An online training lecture system was used to teach the associate dentists and hygienists. Guest speakers were invited to attend this.

The practice asked for and listened to the views of patients and staff. Health checks were provided for staff.