Updated 20 April 2018
We carried out this unannounced inspection on 14 February 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.
We told the NHS England Cheshire and Merseyside area team that we were inspecting the practice. They provided information which we took into account.
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 not 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 not providing well-led care in accordance with the relevant regulations.
Background
Highfields Dental Practice is close to the centre of Crewe and provides dental care and treatment to adults and children on a privately funded basis.
The provider has a portable ramp available to facilitate access to the practice for wheelchair users. The practice has two treatment rooms. Car parking is available near the practice.
The dental team includes one locum dentist, one dental hygiene therapist, three dental nurses, two of whom are trainees, and one receptionist. The provider manages the practice.
The practice is owned by an individual. 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.
The premises is shared with another separately registered dental service provider.
During the inspection we spoke to the three dental nurses. We looked at practice policies, procedures and other records about how the service is managed.
The practice is open:
Monday to Friday 8.30am to 5.30pm
Our key findings were:
- The practice was clean and well maintained.
- The practice had infection control procedures in place which reflected published guidance.
- The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
- The practice had a procedure in place for dealing with complaints.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
- The practice asked patients and staff for feedback about the services they provided.
- Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available with the exception of a child sized self-inflating resuscitation bag.
- The practice had systems in place to help them manage risk, but had not put in place all reasonably practicable measures to reduce these risks.
- The practice had staff recruitment procedures in place. Some pre-employment checks had not been carried out.
- Staff had limited access to supervision and support.
We identified regulations the provider was not meeting. They must:
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Full details of the regulations the provider was not meeting are at the end of this report.
There were areas where the provider could make improvements and should:
- Review the practice’s whistleblowing policy to ensure that details of external organisations are included should staff wish to raise concerns.
- Review the availability of equipment to manage medical emergencies taking into account the guidance issued by the Resuscitation Council (UK), and the General Dental Council.
- Review the practice’s protocols in relation to the use of closed circuit television to ensure staff and patients are fully informed as to its purpose and their right to access footage, and ensure registration with the Information Commissioner’s Office is current.
- Review the availability of an interpreter service for patients who do not speak English as their first language.