You are here

Broxbourne Dental Care - Broxbourne

Inspection Summary


Overall summary & rating

Updated 18 June 2018

We carried out this announced inspection on 14 May 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

Broxbourne Dental Care is in Broxbourne and provides NHS (22%) and private (78%) treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available behind the practice.

The dental team includes eight dentists, nine dental nurses, three dental hygienists, two receptionists and one practice manager/receptionist. The practice has six treatment rooms.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Broxbourne Dental Care was the principal dentist.

On the day of inspection we collected 35 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with three dentists including the foundation dentist, two dental nurses, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 8am to 6.30pm.

Tuesday from 8am to 6pm.

Wednesday from 8am to 6pm.

Thursday from 8am to 6pm.

Friday from 8am to 5pm.

Saturday from 8am to 12 noon.

Our key findings were:

  • The practice staff had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were mostly available with the exception of some airways sizes 0 and 4 and paediatric pocket masks which were immediately ordered.
  • The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • 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 practice was providing preventive care and supporting patients to ensure better oral health.
  • The appointment system met patients’ needs.
  • The practice had 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 practice staff dealt with complaints positively and efficiently.

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

  • Review staff training to ensure that dental nursing staff who assist in conscious sedation have the appropriate training and skills to carry out the role, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015'.
  • Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
  • Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.
Inspection areas

Safe

No action required

Updated 18 June 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 used learning from incidents and complaints to help them improve.

Staff received training in safeguarding 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. There were no records of gas and fixed wire testing retained at the practice. The pulse oximeter had not been serviced or calibrated.

The practice followed national guidance for cleaning, sterilising and storing dental instruments. We found there was no hand washing sink in the practice decontamination room. Staff were using either the sink in the kitchen or the sink in the staff toilet to wash their hands both before and after the decontamination process.

Bi-annual infection control audits had been undertaken. There was a lack of risk assessments including the safe use of needles and sharp dental instruments and substances hazardous to health.

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

Effective

No action required

Updated 18 June 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 given with care and consideration. The dentists discussed treatment with patients so they could give informed consent and recorded this in their records.

Staff who supported the sedationist had not undertaken training other than in-house training provided by the sedationist. We were told staff had training for Immediate Life Support scheduled for November 2018.

The practice had clear arrangements when patients needed to be referred to other dental or health care professionals.

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

Caring

No action required

Updated 18 June 2018

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

We received feedback about the practice from 37 people. Patients were positive about all aspects of the service the practice provided. They told us staff were professional, friendly and polite.

They said that they were given helpful, positive and informative advice 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 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 18 June 2018

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

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 sight or 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 18 June 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 looked at a sample of dental care records and found that some records lacked detail of discussions regarding options, risks and benefits and therefore informed consent. There was a lack of audit of dental care records.

There was a lack of risk assessment in place to ensure the practice monitored clinical and non-clinical areas of their work and to help them improve and learn.

The practice asked for and listened to the views of patients and staff.