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Nottingham Emergency Dental Services Limited

Inspection Summary


Overall summary & rating

Updated 25 January 2017

We carried out an announced comprehensive inspection on 15 November 2016 to ask the service 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 service is located on the ground floor of premises to the west of the city centre close to the Queens Medical Centre (QMC). The service provides a mixture of NHS and private out-of-hours emergency dental treatments and a minor oral surgery service (IMOS). There is a small car park located at the service. There are two treatment rooms all of which are located on the ground floor.

The service provides out-of-hours regulated emergency dental services to both adults and children. Services provided include emergency general dentistry, Planned minor oral surgery up to three times a week.

The service’s opening hours are – Monday to Friday: 7 pm to 9:15 pm with access through referral from the NHS 111; Saturday: 2 pm to 5 pm and 6 pm to 9 pm; Sunday: 9 am to 12 noon, 2 pm to 5 pm and 6 pm to 9pm. In addition the service has a contract for minor oral surgery with NHS referrals from dentists on Tuesday and Wednesday: 9:30 am to 2:30 pm and Saturday: 8:30 am to 1 pm.

The clinical director who is a dentist 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.

The practice has 13 dentists and 23 qualified dental nurses; Dental nurses also worked on the reception desk.

Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received feedback from 17 patients who provided a positive view of the services the practice provides. All of the patients provided positive feedback.

Our key findings were:

  • The premises were visibly clean and there were systems and processes in place to maintain the cleanliness.
  • Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
  • Patients commented they had no problem getting an appointment that suited their needs.
  • Patients were able to access emergency treatment when they were in pain.
  • Patients provided positive feedback about their experiences at the practice. Patients said they were treated with dignity and respect; and the dentist involved them in discussions about treatment options and answered questions.
  • Patients’ confidentiality was protected.
  • There were systems to record accidents, significant events and complaints, and where learning points were identified these were shared with staff.
  • The records showed that apologies had been given for any concerns or upset that patients had experienced at the practice.
  • The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
  • There was a whistleblowing policy accessible to all staff, who were aware of procedures to follow if they had any concerns.
  • Where audits identified improvements were needed these had not always been followed through.
  • The practice had the necessary equipment for staff to deal with medical emergencies, and staff had been trained how to use that equipment. This included an automated external defibrillator, oxygen and emergency medicines.

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

  • Review the service’s audit protocols of various aspects of the service, such as dental care records at regular intervals to help improve the quality of service. The service should also check all audits have documented learning points and the resulting improvements can be demonstrated.
Inspection areas

Safe

No action required

Updated 25 January 2017

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

All staff had received up-to-date training in safeguarding vulnerable adults and children. There were clear guidelines for reporting concerns and the service had a lead member of staff to offer support and guidance over safeguarding matters. Staff knew how to recognise the signs of abuse, and how to raise concerns when necessary. Information regarding safeguarding was displayed throughout the service.

The service had emergency medicines and oxygen available, and an automated external defibrillator (AED). Regular checks were being completed to ensure the emergency equipment was in good working order.

Recruitment checks were completed on all new members of staff. This was to ensure staff were suitable and appropriately qualified and experienced to carry out their role.

The service was visibly clean and had infection control procedures to ensure that patients were protected from potential risks. Regular audits of the decontamination process had been undertaken as recommended by the current guidance.

X-ray equipment was regularly serviced and inspected to make sure it was safe for use.

Effective

No action required

Updated 25 January 2017

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

All patients were clinically assessed by a dentist before any treatment began. The service used a recognised assessment process to identify any potential areas of concern in a patient’s mouth including their soft tissues (gums, cheeks and tongue).

Staff had received an appraisal to identify their learning needs and monitor their development and progress.

The service had systems in place for making referrals to other dental professionals when it was clinically necessary.

Caring

No action required

Updated 25 January 2017

We found that this service was providing caring services in accordance with

the relevant regulations.

Patient confidentiality was maintained and dental care records were stored securely.

Feedback from patients identified staff were friendly, and treated patients with care and concern. Patients also said they were treated with dignity and respect.

There were systems for patients to be able to express their views and opinions.

Responsive

No action required

Updated 25 January 2017

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

Patients who were in pain or in need of urgent treatment were assessed and if necessary could usually get an appointment the same day.

The practice had two ground floor treatment rooms which allowed easy access for patients with restricted mobility or mothers with prams or pushchairs.

A formal disabled access audit in line with the Equality Act (2010) was completed in October 2016 and a copy sent to CQC after this inspection. The access audit was to consider the needs of patients with restricted mobility.

There were arrangements for emergency dental treatment outside of normal working hours, including weekends, evenings and public holidays which were clearly displayed in the service and in the service leaflet.

There were systems and processes to support patients to make formal complaints.

Well-led

No action required

Updated 25 January 2017

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

There was a clear management structure at the service. Staff were aware of their roles and responsibilities within the dental team, and knew who to speak with if they had any concerns.

The service had a system for carrying out audits of both clinical and non-clinical areas to assess the safety and effectiveness of the services provided. The system for auditing could be more robust. We were informed policies and procedures had been kept under review.

Patients were able to express their views and comments, and the service listened to those views and acted upon them.

Staff said the service was a friendly place to work, and they could speak with a senior colleague if they had any concerns.