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Inspection Summary


Overall summary & rating

Updated 16 December 2016

We carried out an announced comprehensive inspection on 20 October 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

Knowle Smile Spa is a dental practice providing general dental services on a NHS and private basis. The practice also offered dental implants and orthodontic treatment. The service is provided by two dentists (one of whom is the provider) and a hygienist. They are supported by two dental nurses, a practice manager and a receptionist. All of the dental nurses also carry out reception 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, toilet facilities, a decontamination room and three treatment rooms on the ground floor. The first floor comprises of storage rooms, an office, kitchen, staff room and toilet facilities. There is also an area for developing X-rays on the ground floor. There is a basement and this holds the compressor (pressure vessel equipment). The practice is open between 9am and 5:45pm on Monday to Thursday, and between 9am and 5pm on Fridays.

The provider is registered with the Care Quality Commission (CQC) as an individual. 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.

Twenty-two patients provided feedback about the practice. We looked at comment cards patients had completed prior to the inspection and we also spoke with three patients. The information from patients was overwhelmingly complimentary. Patients were positive about their experience and they commented that staff were gentle and caring and the practice was always immaculate.

Our key findings were:

  • The practice was organised and appeared clean and tidy on the day of our visit. Many patients also commented that this was their experience.
  • Patients told us they found the staff very caring and friendly. Patients were able to make routine and emergency appointments when needed.
  • Infection control standards met national 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.
  • 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 well maintained.
  • 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.
  • Practice meetings were used for shared learning.
  • The practice 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 procedures that identify the servicing and testing requirements of the X-ray equipment to ensure these are carried out in a timely manner.
  • Review the X-ray equipment and consider fitting a rectangular collimator to any new X-ray equipment that is installed in future. This was already present on some of the equipment at the practice but not all due to the old design of some of the equipment.
  • Review the practice’s procedures for identifying and repairing any defects in the cabinetry in the treatment rooms.
Inspection areas

Safe

No action required

Updated 16 December 2016

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

The practice had systems to assess and manage risks to patients. These included whistleblowing, complaints, safeguarding and the management of medical emergencies. It also had a recruitment process to help ensure the safe recruitment of staff.

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

The practice was carrying out infection control procedures as described in the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary dental practices’. We identified some small defects affecting the cabinetry in two treatment rooms on the day of our visit to which the provider responded promptly.

Staff told us they felt confident about reporting accidents and incidents. Staff were aware of the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).

Effective

No action required

Updated 16 December 2016

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

Staff were appropriately registered in their roles, and had access to ongoing training and support.

The dentists followed national guidelines when delivering dental care. These included FGDP and National Institute for Health and Care Excellence (NICE). We found that preventative advice was given to patients in line with the 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 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 and options were explained. Record keeping was mostly in line with guidance issued by the Faculty of General Dental Practice (FGDP). We identified that the dentists did not always record information pertaining to the different treatment options available although patients confirmed these discussions took place. The provider responded promptly with plans to improve this area of record keeping.

Caring

No action required

Updated 16 December 2016

We found that this practice was providing caring services in accordance with the relevant regulations.

On the day of the inspection we observed privacy and confidentiality were maintained for patients using the service. Patient feedback was extremely positive about the care they received from the practice. Patients described staff as caring and professional. Patients commented they felt involved in their treatment and the dentists were good at listening to them. Nervous patients said they felt at ease here and the staff were supportive and understanding. Several patients commented that the practice was child-friendly and relaxing.

Responsive

No action required

Updated 16 December 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. They were usually able to see patients requiring urgent treatment within 24 hours. Patients were able to contact staff when the practice was closed and arrangements were subsequently made for these patients requiring emergency dental care.

The practice had an effective complaints process.

The practice offered access for patients with limited mobility.

Well-led

No action required

Updated 16 December 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 we spoke with felt supported in their own particular roles.

There were systems in place to monitor the quality of the service including various audits. The practice used several methods to successfully gain feedback from patients. Staff meetings took place on a regular basis.

The practice carried out audits such as radiography, dental care record keeping and infection control at regular intervals to help improve the quality of service.