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Clarence House Dental Health Centre

Inspection Summary


Overall summary & rating

Updated 13 April 2017

We carried out an announced comprehensive inspection on 23rd February 2017

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

Clarence House Dental Health Centre is located in the centre of Gloucester and provides private treatment to adults and NHS treatment to children. The practice consists of four treatment rooms, toilet facilities for patients and staff, a reception area, waiting areas, a consulting room, a staff room and an office.

The practice offers routine examinations and treatment. There are two dentists, two dental therapists/hygienists, one hygienist, eight dental nurses, two receptionists and a practice manager.

The practice’s opening hours are

8.00 to 19.00 on Monday

8.00 to 17.00 on Tuesday

8.00 to 17.00 on Wednesday

8.00 to 19.00 on Thursday

8.00 to 15.45 on Friday

They also open on the first Saturday in the month for half a day.

The practice is part of an independent group of dentists who run an on-call rota. Out of hours patients were directed to phone the dentist on-call.

We carried out an announced, comprehensive inspection on 23rd February 2017. The inspection was led by a CQC inspector who was accompanied by a specialist dental advisor.

For this inspection 49 people provided feedback to us about the service. Patients were positive about the care they received from the practice. They were complimentary about the service offered’ which they said was very good and excellent. They told us that staff were professional, welcoming, helpful, caring and friendly and the practice was clean and hygienic.

Our key findings were:

• Safe systems and processes were in place, including a lead for safeguarding but there was no lead for infection control.

• Staff recruitment policies were appropriate and most of the relevant checks were completed. Staff received relevant training.

• The practice had ensured that risk assessments were in place.

• The clinical equipment in the practice was appropriately maintained. The practice appeared visibly clean throughout although some surgeries and the decontamination room were cluttered.

•The process for decontamination of instruments followed relevant guidance.

• The practice maintained appropriate dental care records and patients’ clinical details were updated.

• Patients were provided with health promotion advice to promote good oral care.

• Consent was obtained for dental treatment.

• The dentists were aware of the process to follow when a person lacked capacity to give consent to treatment.

• All feedback that we received from patients was positive; they reported that it was a professional, caring and friendly service.

• There were arrangements for governance at the practice such as systems for auditing patient records and radiographs.

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

  • Review the procedures for reporting accidents to include written information for staff about the process for reporting accidents and incidents.

  • Review the system of team meetings to make sure practice based subjects such as health and safety, learning from accidents and incidents and learning from complaints are included as a regular agenda item.

  • Develop policies and procedures about the duty of candour, to support a culture of openness and transparency.

  • Review the recruitment procedures to ensure that written references are obtained before new staff start work in the practice in line with current guidance.

  • Review the arrangements for support to staff to make sure all staff receive regular appraisals and personal development plans at least once a year.

  • Review the arrangements for storing items in the surgeries and the decontamination room to make surfaces easier to clean.

  • Review the arrangements for communication to include a hearing loop for patients with a hearing impairment and access to a translation service for people whose first language is not English.

  • Review the arrangements for infection control to make sure a member of staff takes lead responsibility for infection control.
Inspection areas

Safe

No action required

Updated 13 April 2017

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

There were systems for reporting incidents and for learning from incidents but these could be improved. Staff had received training about safeguarding adults and children. There were policies about safeguarding and whistleblowing and staff knew how to report any concerns.

There were also arrangements for dealing with foreseeable emergencies, for fire safety and for managing risks to patients and to staff. There was a business continuity plan. Hazardous substances were managed safely.

Most of the appropriate checks were being made to make sure staff were suitable to work with people. However, references were not always obtained before staff started to work in the practice. Emergency medicines were in place. Equipment was regularly serviced and X-rays were dealt with safely.

The surgeries were fresh and clean and guidance about decontamination of instruments was being followed to reduce the risk of the spread of infection.

Effective

No action required

Updated 13 April 2017

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

The dentists took X-rays at appropriate intervals. The practice was checking the condition of the gums for every patient and they were checking for oral cancers. Patients completed medical history questionnaires and these were updated at each visit. The practice kept up to date with current guidelines and research. They promoted the maintenance of good oral health through information about effective tooth brushing. The dentists discussed health promotion with individual patients according to their needs.

The practice had sufficient staff to support the dentists. Staff received appropriate professional development and all of the expected training.

The practice had suitable arrangements for working with other health professionals and making appropriate referrals to ensure quality of care for their patients. Patients were asked for consent to treatment. Patients told us that the dentists discussed options for treatment with them. The patient records recorded options for treatment to help patients to make decisions about their care. The dentists showed understanding about the Mental Capacity Act 2005 (MCA) and what they would do if an adult lacked the capacity to make particular decisions for themself.

Caring

No action required

Updated 13 April 2017

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

Staff in the practice were polite and respectful when speaking to patients. Patients’ privacy was respected and treatment room doors were closed during consultations. The practice used an electronic record system and the computer screens in reception were shielded so that they could not be seen by patients.

Patients were positive about the care they received from the practice. They reported that staff were professional, helpful, caring and friendly. Patients told us that they were involved in decisions about their care and gave consent to treatment.  

Responsive

No action required

Updated 13 April 2017

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

The practice had a system to schedule enough time to assess and meet patients’ needs. Patients said that they could get an appointment easily. Emergencies were usually fitted in on the day the patient contacted the practice. The practice actively sought feedback from patients on the care being delivered. There was a procedure about how to make a complaint and the process for investigation. We saw evidence that the practice responded to feedback made direct to the practice and made changes when necessary.

There was an equality and diversity policy and staff had received training about equality and diversity. There was a stair lift to the surgeries and there was a toilet with disabled access. However, there was no hearing loop system for patients who had a hearing impairment and there was no information about translation services for people whose first language was not English.

Well-led

No action required

Updated 13 April 2017

We found that this practice was providing well-led care in accordance with the relevant regulations.

The practice had set up systems for clinical governance such as audits of the infection control, record keeping and radiographs. There were checks of equipment. The autoclave and compressor were serviced and there were daily checks of the autoclave.

The practice had a range of policies which were made available to staff.

The practice manager was the lead for the practice one of the dentists was the lead for safeguarding and the other dentist was the lead for medical emergencies. However, there was no infection control lead. There was a whistleblowing policy but there was no information for staff about the duty of candour and the need to be open if an incident occurred where a patient suffered harm. So far there had been no such incidents.

The practice manager held team meetings once a month, there were monthly nurses’ meetings and weekly management meetings. Staff were responsible for their own continuing professional development and kept this up to date.

The practice was seeking feedback from patients through patient satisfaction questionnaires and the NHS friends and family test. They made improvements in response to the feedback.