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Inspection Summary


Overall summary & rating

Updated 25 February 2016

We carried out an announced comprehensive inspection on 20 October 2015 to ask the practice 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

Eternal Smiles Dental Centre provides general dental services predominantly on a private basis (fee per item) although they do hold a small NHS contract (30%). The services provided include predominantly routine restorative and preventative dental treatment but also implants. The service is provided by the practice owner (provider). They are supported by one dental nurse, one receptionist and a practice manager. The practice is located on the first floor in a building in the heart of Solihull town centre. There is a staircase leading to the first floor and there is no access to facilities for patients who are disabled or those with limited mobility. There is a waiting room, two treatment rooms, a decontamination room, a reception area, a storage room and toilet facilities. The practice is located close to local amenities and bus services and there is a car park close to the practice. The practice opens from Monday to Saturday at 9am. Closing times vary throughout the week from 3pm to 7pm.

The provider is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

30 patients provided feedback about the practice. We looked at comment cards patients had completed prior to the inspection and we also spoke with patients on the day of the inspection. Overall the information from patients was very positive. Patients were positive about their experience and they commented that they were treated with care, respect and dignity. Staff told us that they always interacted with them in a respectful, appropriate and kind manner. Some patients told us the practice did not always provide them with a written treatment plan.

Our key findings were:

  • There was appropriate equipment for staff to undertake their duties, and equipment was well maintained. They had access to an automated external defibrillator (AED). An AED is a portable electronic device that analyses life threatening irregularities of the heart including ventricular fibrillation and is able to deliver an electrical shock to attempt to restore a normal heart rhythm.
  • The practice had systems to assess and manage risks to patients, including infection prevention and control, health and safety, safeguarding and the management of medical emergencies.
  • Staff received training appropriate to their roles.
  • Patients told us they were treated with respect and dignity by staff. Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood. Patients commented they felt involved in their treatment and that it was fully explained to them.
  • Patients were able to make routine and emergency appointments when needed.
  • The practice had an effective complaints system in place and there was an openness and transparency in how these were dealt with.
  • Staff told us they felt well supported and comfortable to raise concerns or make suggestions.
  • Audits were undertaken regularly but were not always complete as action plans were not always documented.

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

  • Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
  • Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice (FGDP) regarding clinical examinations and record keeping.
  • Check all audits have learning points documented and resulting improvements can be demonstrated.
  • Review the practice's recruitment policy and procedures to ensure character references for new staff as well as proof of identification are requested, reviewed and recorded suitably.
  • Maintain minutes for staff meetings as they are useful review documents for staff to reference at a later date.
  • Maintain a business continuity plan that is comprehensive and specific to this practice.
  • Make arrangements so that the practice has access to an interpreting service for patients who cannot speak English (or any other language spoken by the provider).
Inspection areas

Safe

No action required

Updated 25 February 2016

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

Staff told us they felt confident about reporting incidents, accidents and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). There had not been any incidents in the last 12 months but there was a system in place to act upon any incidents which may occur in the future.

The practice had systems to assess and manage risks to patients, whistleblowing, complaints, safeguarding, health and safety and the management of medical emergencies. Their recruitment process needed some improvement to ensure the safe recruitment of new staff.

Patients’ medical histories were obtained before any treatment took place. The dentist was aware of any health or medication issues which could affect the planning of treatment. Staff were trained to deal with medical emergencies. All emergency equipment and medicines were in date and in accordance with the British National Formulary (BNF) and Resuscitation Council UK guidelines.

Effective

No action required

Updated 25 February 2016

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

The practice monitored any changes to the patients’ oral health and made referrals for specialist treatment or investigations where indicated. Explanations were given to patients in a way they understood and risks, benefits, options and costs were explained. Patients’ dental care records provided information about their medical history, dental treatment and oral health advice. However, improvements were required so that record keeping was in line with guidance issued by the FGDP.

Staff had an excellent awareness about the importance of gaining patients’ consent to care and treatment and this was documented. Staff members were familiar with the requirements of the Mental Capacity Act 2005 and acted appropriately when managing patients that lacked the capacity to consent.

The dentist mostly followed national guidelines when delivering dental care. These included FGDP and National Institute for Health and Care Excellence (NICE). We found a limited application of guidance issued in the Department of Health publication 'Delivering better oral health: an evidence-based toolkit for prevention' when providing preventive oral health care and advice to patients. This is an evidence based toolkit used by dental teams for the prevention of dental disease in a primary and secondary care setting. The dentist told us this was because their patients mostly had very low levels of dental disease.

Caring

No action required

Updated 25 February 2016

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

the relevant regulations.

We observed privacy and confidentiality were maintained for patients using the service on the day of the inspection. Patient feedback was very positive about the care they received from the practice; they told us they were treated with kindness. Patients commented they felt involved in their treatment, it was fully explained to them and they were listened to.

Responsive

No action required

Updated 25 February 2016

We found that this practice was providing responsive care in accordance with

the relevant regulations.

The practice had an efficient appointment system in place to respond to patients’ needs. There were vacant appointment slots for emergency appointments each day. Patients commented they could access treatment for emergency care when required. There were clear instructions for patients requiring urgent care when the practice was closed.

There was an effective procedure in place for acknowledging, recording, investigating and responding to complaints made by patients. This system was used to improve the quality of care.

The practice was unable to accommodate patients with a disability or limited mobility but new patients were always informed of this prior to booking any appointments.

Well-led

No action required

Updated 25 February 2016

We found that this practice was providing well-led care in accordance with

the relevant regulations.

There was a clearly defined management structure in place and staff all felt supported in their own particular roles. The provider was responsible for the day to day running of the practice.

There were several systems in place to monitor the quality of the service. Several audits had been undertaken but some were incomplete as they did not have action plans to address areas for improvement. The practice used various methods to successfully gain feedback from patients and staff.

Daily practice meetings were held but not minuted. The provider told us they would arrange for formal meetings on a monthly basis in addition to the informal daily meetings. These provided staff the opportunity to discuss concerns and any suggestions.