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Bupa Dental Care Bishops Stortford

Inspection Summary


Overall summary & rating

Updated 19 February 2019

We undertook a follow up inspection of Bupa - Barrett House Dental Centre, on 17 January 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Bupa - Barrett House Dental Centre on 14 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. As a result of that inspection, we found the registered provider was not providing well led care and was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Bupa - Barrett House Dental Centre on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breach we found at our inspection on 14 June 2018.

Background

Bupa - Barrett House Dental Centre is in Bishops Stortford and provides NHS and private treatment for adults and children.

There is level and stair lift access for people who use wheelchairs and those with pushchairs. Car parking spaces, including two for blue badge holders, are available outside the practice.

The dental team includes ten dentists, one specialist orthodontist, one endodontist, one oral surgeon and one periodontist, seven dental nurses (including two lead nurses), two trainee dental nurses, two dental hygienists, three receptionists, one practice coordinator and a practice manager. The practice has nine treatment rooms and two decontamination rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of inspection, the previous practice manager was still registered as the manager but had recently retired. A new practice manager was in post and the practice were in the process of nominating a new registered manager. A registered manager is legally responsible for the delivery of services for which the practice is registered.

During the inspection we spoke with the practice manager, the practice coordinator and the clinical support lead for the provider organisation. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday from 8am to 7pm.

Friday from 8am to 4pm.

Saturday from 9am to 1pm.

Our key findings were:

  • There were effective systems and processes in place to ensure good governance in accordance with the fundamental standards of care.
  • The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Policies, protocols and safeguarding contact information had been reviewed and updated and was easily accessible to staff.
  • Recruitment information was held at the practice and was in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
  • There were systems in place to ensure the security of NHS prescription pads in the practice and to track and monitor their use.
  • Staff had undertaken training on the requirements of the Mental Capacity Act 2005 and were aware of their responsibilities under the Act and how it related to their role. In addition, staff were aware of Gillick competency and their responsibilities in relation to this.
  • Staff had a clear awareness of the need for the practice to establish parental responsibility when seeking consent for children and young people.
  • There were systems in place to ensure the secure storage of dental care records.
Inspection areas

Safe

No action required

Updated 19 February 2019

Effective

No action required

Updated 19 February 2019

Caring

No action required

Updated 19 February 2019

Responsive

No action required

Updated 19 February 2019

Well-led

No action required

Updated 19 February 2019

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

The provider had made improvements to the management of the service. This included more robust systems for monitoring, assessing and improving the quality and safety of the service. There were cohesive systems for review and analysis of complaints and untoward events. We found there was improved staff training which included staff understanding of the duty of candour and protecting patients’ personal information. We saw infection control audits had been undertaken and staff were undergoing regular appraisals and reviews. In addition, we noted there was additional staff time available for management and administration, and roles and responsibilities had been established for all the practice team. The improvements provided a sound footing for the ongoing development of effective governance arrangements at the practice.