Archived: Upton-upon-Severn Dental Surgery

We carried out this announced inspection on 7 November 2017 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

Upton-upon-Severn Dental Surgery is located within a modern purpose built centre called Upton-upon-Severn Health Centre which is shared with other healthcare providers. Upton-upon-Severn Dental surgery provides predominantly NHS dental treatments to patients of all ages. This is a vocational training practice for dentists and is currently supporting a newly qualified foundation dentist.

The dental team includes three dentists, one foundation dentist, seven dental nurses who also support in reception, two apprentice dental nurses, a dental hygiene therapist, two receptionists and a practice manager who is also a qualified dental nurse.

The practice is on the ground floor of the building and has level access for wheelchair users and pushchairs. There is shared use of three patient toilets (one of which is an assisted toilet with an assistance bell, grab rails and a baby change unit) and the Health Centre benefits from a dedicated on site car park with 10 spaces available for blue badge holders. The practice has a designated waiting area, a reception with back office areas, four dental treatment rooms, a staff kitchen, a staff toilet and a decontamination room for the cleaning, sterilising and packing of dental instruments. In addition to this staff share communal facilitates such as changing rooms, a large kitchen and a lounge with other healthcare professionals in the building.

The practice is jointly 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 43 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, the foundation dentist, two dental nurses, one apprentice dental nurse, one dental hygiene therapist 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: 8.45am – 5.15pm

Tuesday: 8.45am – 5.15pm

Wednesday: 8.45am – 5.15pm

Thursday: 8.45am – 5.15pm

Friday: 8.45am – 5.15pm

Closed every lunch time 12pm – 1.30pm

Our key findings were:

• The practice was visibly clean and a contracted cleaning company were responsible for the day to day cleaning.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were mostly available. On the day of our inspection the practice did not have a full range of face masks for the self-inflating bag, did not have eye wash and were not recording the oxygen checks that they were completing. The missing equipment was ordered following our inspection and weekly logs were adapted to include the oxygen checks.
• The practice had systems to help them manage risk.
• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• 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 appointment system met patients’ needs. Due to demand and large patient numbers the practice were not accepting new NHS patients at the time of our visit to keep waiting times for routine appointments down to a minimum.
• The practice had effective leadership. Staff we spoke with felt well supported by the principal dentist and practice manager and were committed to providing a quality service to their patients.
• The practice asked staff and patients for feedback about the services they provided and displayed results in the patient information folder.
• The practice dealt with complaints positively and efficiently.

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

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the management of prescription pads in the practice and ensure there are systems in place to track and monitor their use.