Abbey Cottage Dental Practice Limited

Updated 16 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was carried out on 9 November 2016 by a CQC inspector and a dental specialist adviser. We reviewed information we held about the provider and information that we asked them to send us in advance of the inspection. Due to circumstances beyond the practice’s control they were not able to provide this until the day of the inspection.

During the inspection we spoke with the registered manager and one other dentist, dental nurses and reception staff. We looked around the premises including the treatment rooms. We viewed a range of policies and procedures and other documents and read the comments made by 30 patients in comment cards provided by CQC before the inspection. We spoke with three patients at the practice on the day of the inspection. The practice provided their NHS Friends and Family Test results from the 64 responses from patients since they began to use it in April 2015

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 16 December 2016

We carried out an announced comprehensive inspection on 9 November 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

Abbey Cottage Dental Practice is situated in the Herefordshire market town of Ledbury and is in the town centre. It provides mainly NHS dental treatment for all age groups and a small amount of private dental treatment. There has been a dental practice at the premises for many years and has been operated by a limited company, Abbey Cottage Dental Practice Limited for over 15 years.

The director of the company is the principal dentist and 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.

The practice has three dentists, a dental hygienist and six dental nurses. The registered manager and clinical team are supported by a practice manager and a receptionist. Some of the dental nurses also carry out reception duties.

The practice has three dental treatment rooms and a separate decontamination room for the cleaning, sterilising and packing of dental instruments. The waiting and reception areas are in the same room. The practice building is listed and has some constraints for people with mobility difficulties. There are three steps into the building from the pavement outside, two treatment rooms are on the first floor and there are also steps up to the ground floor treatment room. The practice has a portable ramp which they use to assist patients in and out of the building and the ground floor treatment room. The practice does not have its own parking.

The practice is open from 8.45am to 5pm Monday to Friday with appointments available from 9am. It closes for lunch from 1pm to 2pm.

Before the inspection we sent Care Quality Commission comment cards to the practice so patients could give us their views about Abbey Cottage Dental Practice. We collected 30 completed cards and spoke with three patients while we were at the practice. Patients were very positive about the practice and described the dentists and other members of the team as understanding, approachable and caring. Several explained that they had been patients at the practice for 10 years or more and told us that they and their families had always received professional, kind and sensitive care. A number of patients described their appreciation of the sensitive way the practice supported them to cope with their anxieties about dental treatment. Some parents said their children had grown up without a fear of the dentist because of the care the practice took. Those who commented on cleanliness confirmed that the practice was clean and tidy.

Our key findings were:

• The practice was visibly clean and feedback from patients confirmed this was their experience. National guidance for cleaning, sterilising and storing dental instruments was followed.
• The practice had suitable safeguarding processes and staff understood their responsibilities for safeguarding adults and children.
• The practice had arrangements for dealing with medical emergencies.
• Dental care records provided information about patients’ care and treatment and patients received written treatment plans where necessary.
• Staff received training appropriate to their roles and were supported to meet the General Dental Council’s continuous professional development requirements.
• Patients were able to make routine and emergency appointments when needed and gave us positive feedback about the service they received.

• The practice used the NHS Friends and Family Test, to enable patients to give their views about the practice. Staff had opportunities to contribute their views through informal daily contact with each other, staff meetings and annual appraisals.

• The practice had policies and procedures to help them manage the service and were in the process of changing over to new formats resulting in some overlap and duplication of documentation. We were aware that completion of this work was delayed by circumstances outside the registered manager’s control.

• Recruitment arrangements were in place but not sufficiently structured to provide a robust and consistent process.

• The practice used audit as a means to monitor quality in a range of areas.

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

• Review the practice’s recording arrangements for safety alert information received at the practice.
• Review the practice's recruitment procedures to provide a robust and consistent process which includes specific guidance regarding information required for staff being recruited.
• Review the availability of information about translation services for patients who do not speak English as their first language or who use British Sign Language. They should also review the provision of an induction hearing loop to assist patients who use hearing aids.

• Review and implement the practice’s X-ray audit action plan.

• Review the practice’s policies, procedures and other documentation to consolidate the recently adopted and previous versions to create one comprehensive set of documents that are tailored to the specific needs of the practice.