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Inspection Summary


Overall summary & rating

Updated 20 April 2017

We carried out an announced comprehensive inspection on 28 February 2017 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 Carnegie Clinic is situated in Shipley, West Yorkshire. The practice provides dental treatment to adults and children on an NHS or privately funded basis. The services include preventative advice and treatment and routine restorative dental care.

The practice has four surgeries, a decontamination room, two waiting areas and a reception area. There are two surgeries, a waiting area, the reception area and accessible toilet facilities on the ground floor. The other two surgeries and the second waiting area are on the second floor.

There are three dentists, three dental hygiene therapists, one dental hygienist, six dental nurses (two of whom are trainees), one receptionist and a practice manager.

The opening hours are Monday from 9:00am to 7:00pm, Tuesday and Friday from 8:00am to 4:00pm and Wednesday and Thursday from 10:00am to 7:00pm.

The practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

During the inspection we received feedback from 33 patients. The patients were positive about the care and treatment they received at the practice. Comments included staff were polite, considerate and helpful. They also commented that it was easy to book an appointment and they were made to feel at ease and the practice is clean and hygienic.

Our key findings were:

  • The practice was visibly clean and uncluttered.
  • The practice had systems in place to assess and manage risks to patients and staff including health and safety and the management of medical emergencies.
  • Staff were qualified and had received training appropriate to their roles.
  • Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
  • Dental care records showed treatment was planned in line with current best practice guidelines.
  • Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
  • We observed patients were treated with kindness and respect by staff.
  • Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
  • The practice had a complaints system in place and there was an openness and transparency in how these were dealt with.
  • Patients were able to make routine and emergency appointments when needed.
  • The governance systems were effective.
  • There were clearly defined leadership roles within the practice and staff told us they felt supported, appreciated and comfortable to raise concerns or make suggestions.

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

  • Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
  • Review staff awareness of the practice’s safeguarding policy and procedures and ensure all staff are aware of their responsibilities.
  • Review the practice’s process for risk assessing new members of staff who have not yet completed a full course of Hepatitis B vaccinations.
  • Review the practice’s process for monitoring referrals.
Inspection areas

Safe

No action required

Updated 20 April 2017

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

Staff told us they felt confident about reporting incidents and accidents. There was an effective system for the analysis of such events and they were discussed at practice meetings. We noted some MHRA alerts had not been received.

Staff had received training in safeguarding at the appropriate level and knew the signs of abuse. There was some uncertainty amongst staff of which external organisations to report safeguarding concerns.

Staff were suitably qualified for their roles and the practice had undertaken the relevant recruitment checks to ensure patient safety. The practice had not put in risk assessments for staff that had not completed a full course of Hepatitis B vaccination.

Staff were trained to deal with medical emergencies. All emergency equipment and medicines were in date and in accordance with the British National Formulary (BNF) and Resuscitation Council UK guidelines.

The decontamination procedures were effective and the equipment involved in the decontamination process was regularly serviced, validated and checked to ensure it was safe to use.

Effective

No action required

Updated 20 April 2017

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

Patients’ dental care records provided comprehensive information about their current dental needs and past treatment. The practice monitored any changes to the patient’s oral health and provided treatment when appropriate.

The practice followed best practice guidelines when delivering dental care. These included Faculty of General Dental Practice (FGDP), National Institute for Health and Care Excellence (NICE) and guidance from the British Society of Periodontology (BSP). The practice focused strongly on prevention and the dentists were aware of the ‘Delivering Better Oral Health’ toolkit (DBOH) with regards to fluoride application and oral hygiene advice.

Staff were encouraged to complete training relevant to their roles and this was monitored by the practice manager. The clinical staff were up to date with their continuing professional development (CPD).

Referrals were made to secondary care services if the treatment required was not provided by the practice. There was no process in place to actively monitor referrals which had been sent.

Caring

No action required

Updated 20 April 2017

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

During the inspection we received feedback from 33 patients. The patients commented staff were polite, considerate and helpful.

We observed the staff to be welcoming and caring towards the patients.

We observed privacy and confidentiality were maintained for patients using the service on the day of the inspection.

Staff explained that enough time was allocated in order to ensure that the treatment and care was fully explained to patients in a way which they understood.

Responsive

No action required

Updated 20 April 2017

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

The practice had an efficient appointment system in place to respond to patients’ needs. There were vacant appointments slots for urgent or emergency appointments each day.

Patients commented they could access treatment for urgent and emergency care when required. There were clear instructions for patients requiring urgent care when the practice was closed.

There was a procedure in place for responding to patients’ complaints. This involved acknowledging, investigating and responding to individual complaints or concerns. Staff were familiar with the complaints procedure.

The practice had made reasonable adjustments to enable wheelchair users or patients with limited mobility to access treatment.

Well-led

No action required

Updated 20 April 2017

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

There was a clearly defined management structure in place and all staff felt supported and appreciated in their own particular roles. The practice manager was responsible for the day to day running of the practice.

Effective arrangements were in place to share information with staff by means of monthly practice meetings which were well minuted for those staff unable to attend.

The practice regularly audited clinical and non-clinical areas as part of a system of continuous improvement and learning.

They conducted patient satisfaction surveys, were currently undertaking the NHS Friends and Family Test (FFT) and there was a comments box for patients to make suggestions to the practice.