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Inspection Summary


Overall summary & rating

Updated 14 July 2016

We carried out an announced comprehensive inspection on 16 June 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

Sheen Dental is located in the London Borough of Richmond-upon-Thames. The premises are situated in a converted, residential building in a high-street location. There are five treatment rooms, a decontamination room, an X-ray room, administrative offices, reception and waiting areas and patient toilets. These are distributed across the ground and first floors of the building.

The practice provides NHS and private services to adults and children. The practice offers a range of dental services including routine examinations and treatment, veneers and crowns and bridges. The practice also offers specialist services such as implants, orthodontics and conscious sedation.

The staff structure of the practice consists of a principal dentist, three associate dentists, three hygienists, three dental nurses, a practice manager and two receptionists. There is also a specialist orthodontist and a visiting oral surgeon.

The practice opening hours are Monday to Friday from 8.00am to 5.00pm. The practice is also open from 9.00am to 1.00pm on Saturdays.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Fifty-five people provided feedback about the service. Patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

  • Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).

  • There were effective systems in place to reduce and minimise the risk and spread of infection.
  • The practice had safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
  • Staff reported incidents and kept records of these which the practice used for shared learning.
  • There were effective arrangements in place for managing medical emergencies.
  • Equipment, such as the air compressor, fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced. However, systems for managing stock and security of prescription pads could be improved.
  • Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
  • The practice ensured staff maintained the necessary skills and competence to support the needs of patients. However, improvements could be made to ensure a formal staff appraisal process was put in place.
  • The practice had clear procedures for managing comments, concerns or complaints.
  • The provider had a clear vision for the practice and staff told us they were well supported by the staff team.
  • There were arrangements for identifying, recording and managing risks through the use of risk assessments and audit processes. However, we identified some areas where improvements were required.

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

  • Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
  • Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
  • Review the practice’s responsibilities as regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002; ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
  • Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
  • Review recruitment procedures to ensure accurate, complete and detailed records are maintained for all staff.
  • Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.
  • Review systems for seeking and acting on feedback from patients or staff for the purposes of continually evaluating and improving the service.
  • Review its audit protocols to ensure audits of various aspects of the service are undertaken at regular intervals and where applicable learning points are documented  and shared with all relevant staff.
Inspection areas

Safe

No action required

Updated 14 July 2016

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

The practice had systems in place to minimise the risks associated with providing dental services. There were systems in place for identifying, investigating and learning from incidents relating to the safety of patients and staff members. The practice had policies and protocols, which staff were following, for the management of infection control, medical emergencies and dental radiography. There was a safeguarding lead and staff understood their responsibilities in terms of identifying and reporting any potential abuse.

We found the equipment used in the practice was generally well maintained and checked for effectiveness. However, we found some items of equipment in three of the treatment rooms which had either not been pouched and dated, or that had gone past their use by date.

Recruitment procedures could be improved through ensuring that references were always obtained prior to employment and suitably recorded. We also noted that prescription pad security could be improved.

The practice manager assured us that these concerns would be addressed promptly.

Effective

No action required

Updated 14 July 2016

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

the relevant regulations.

The practice provided evidence-based care in accordance with relevant, published guidance, for example, from the General Dental Council (GDC)

. The practice monitored patients’ oral health and gave appropriate health promotion advice. Staff explained treatment options to ensure that patients could make informed decisions about any treatment. The practice worked well with other providers and followed up on the outcomes of referrals made to other providers.

Staff engaged in continuous professional development (CPD) and were meeting all of the training requirements of the General Dental Council (GDC). Staff received supervision from the principal dentist through a system of daily meetings. However, staff had not received appraisals within the past year to discuss their role and identify additional training needs.

The practice manager told us they planned to carry out appraisals by the end of the year.

Caring

No action required

Updated 14 July 2016

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

the relevant regulations.

The practice provided clear, written information for patients which supported them to make decisions about their care and treatment. The dental care records demonstrated that staff provided people with explanations about the risks and benefits of different treatments. This supported people to be involved in making their own choices and decisions about their dental care.

We received positive feedback from patients. Patients felt that the staff were kind and caring; they told us that they were treated with dignity and respect at all times. We found that dental care records were stored securely and patient confidentiality was well maintained.

Responsive

No action required

Updated 14 July 2016

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

the relevant regulations.

Patients generally had good access to appointments, including emergency appointments, which were available on the same day. The culture of the practice promoted equality of access for all. The practice was wheelchair accessible with access via a ramp to two of the treatment rooms and hygienists surgery situated on the ground floor.

There was a complaints policy in place. One complaint had been received within the past year. These had been recorded and investigated. The practice had provided the complainant with a response, although the timeliness of the response could have been improved.

Patient feedback, through the use of feedback forms collected in the waiting area, had been used to monitor the quality of the service provided, although only limited information had been obtained through this method in the past year. The practice also received ad hoc feedback in the form of letters from patients which they reviewed and held on file. The practice manager also told us that the practice had a system for making follow up phone calls with patients to check that they were satisfied with the care received.

Well-led

No action required

Updated 14 July 2016

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

the relevant regulations.

The practice had clinical governance and risk management structures in place. These were maintained and disseminated to all members of staff.

There were areas where risk management and audit processes could be improved. This included protocols in relation to the Control of Substances Hazardous to Health 2002 (COSHH), implementation of the Legionella risk assessment and recruitment policy, and the monitoring of equipment and prescription pads.

We also found that opportunities

for seeking feedback from patients, for the purposes of monitoring and improving the quality of the service, were limited.

Staff were well supervised by the principal dentist during a daily staff meeting. Staff described an open and transparent culture where they were comfortable raising and discussing concerns with each other. They were confident in the abilities of the principal dentist to address any issues as they arose.