Archived: Thorpe House Dental Practice

We carried out this announced focussed inspection on 17 August 2021 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 Care Quality Commission, (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 three questions:

• Is it safe?

• Is it effective?

• 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services well-led?

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

Background

Thorpe House Dental Practice is in Guildford and provides NHS and private dental care and treatment for adults and children.

There is limited level access to the practice for people who use wheelchairs and those with pushchairs. The practice entrance is approached by steps, with supporting handrails, to the entrance pathway and main door, which due to planning restrictions mean the provider cannot easily resolve the issue to achieve a level entrance. Car parking spaces, including dedicated parking for people with disabilities, are available near the practice.

The dental team includes five dentists, two dental nurses, a decontamination technician, and two receptionists. The practice has three treatment rooms.

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.

During the inspection we spoke with two dentists, a dental nurse, a decontamination technician, and a receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday 9am to 5pm
• Tuesday 9am to 5pm
• Wednesday 9am to 5pm
• Thursday 9am to 5pm
• Friday 9am to 5pm

Our key findings were:

• The practice appeared to be visibly 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 not all available.
• The provider had systems to help them manage risk to patients and staff. However, improvements should be made to the Control of Substances Hazardous to Health file.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• We found some out of date dental materials in treatment rooms.
• The provider had staff recruitment procedures which reflected current legislation.
• 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.
• There was no system in place to track and monitor NHS prescription pads.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and a culture of continuous improvement.
• Staff felt involved and supported and worked as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had information governance arrangements.

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

• Improve the practice's processes 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 and the products are stored securely.

• Take action to ensure the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

• Implement an effective system for identifying, disposing and replenishing of out-of-date stock.

• Improve the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.