Archived: Blossomfield Complete Dental Care

Updated 23 January 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

We inspected Blossomfield Complete Dental Care on 8 November 2016. The inspection was carried out by a Care Quality Commission (CQC) inspector and a dental specialist advisor.

Prior to the inspection we reviewed information we held about the provider from various sources. We informed NHS England that we were inspecting the practice. We also requested details from the provider in advance of the inspection and this was submitted late. This included their latest statement of purpose describing their values and objectives and a record of patient complaints received in the last 12 months.

During the inspection we toured the premises, spoke with the provider, the practice manager, one other dentist, one hygienist, two dental nurses and the practice administrator/senior dental nurse. We also reviewed CQC comment cards which patients had completed. We reviewed a range of practice policies and practice protocols and other records relating to the management of the service.

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 23 January 2017

We carried out an announced comprehensive inspection on 8 November 2016 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

Blossomfield Complete Dental Care is a dental practice providing general dental services on a predominantly private basis. NHS services are available to patients under 18 years of age. The service is provided by two dentists. They are supported by two dental hygienists, six dental nurses, two receptionists and a practice manager. A further two members of staff are responsible for sterilising duties.

The practice is located near local amenities and bus routes. There is wheelchair access to the practice and car parking facilities. The premises consist of a waiting room, a reception area, kitchen, staff room, four treatment rooms, a decontamination room and a dedicated room for taking X-rays. Toilet facilities are also available and these offer full access for patients with disabilities. The practice opened at 8:15am on Monday to Thursday and at 8:30am on Fridays. Closing times varied between 3:30pm and 8pm.

The provider is one of two dentists who co-own this practice and both are individually registered with the Care Quality Commission (CQC). This report refers only to Dr Newland’s roles and responsibilities within the practice. 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.

Two patients provided feedback about the practice. We looked at comment cards patients had completed prior to the inspection. The information from patients was complimentary. Patients were positive about their experience and they commented that staff were caring and they were treated well.

Our key findings were:

• The practice was organised and appeared clean and tidy on the day of our visit.
• An infection prevention and control policy was in place. We saw the decontamination procedures generally followed recommended guidance.
• The practice had systems to assess and manage risks to patients, including health and safety, safeguarding, safe staff recruitment and the management of medical emergencies. The practice responded promptly to complete any necessary improvements.
• Dental professionals provided treatment in accordance with current professional guidelines.
• Staff received training appropriate to their roles.
• There was appropriate equipment for staff to undertake their duties, and equipment was generally well maintained.
• The practice had a complaints system in place but improvements were required. Many complainants remained dissatisfied and response times did not meet national guidance.
• Staff told us they felt well supported and comfortable to raise concerns or make suggestions.
• Practice meetings were used for shared learning but these took place on an irregular basis.
• The practice demonstrated that they regularly undertook audits in infection control, radiography and dental care record keeping.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as Public Health England (PHE). They must also ensure that staff are educated accordingly.
• Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by patients in a timely manner.
• Review the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff. They should also review the frequency of staff meetings as regular staff meetings provide the opportunity to share learning and incidents with the whole team.