Archived: Robinson & Dicker Dental Practice

Updated 25 February 2016

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 Robinson & Dicker Dental Practice on 5 October 2015. The inspection team consisted of two CQC inspectors and a dental specialist advisor.

Prior to the inspection we reviewed information we held about the provider from various sources. We informed NHS England and Healthwatch that we were inspecting the practice; however we did not receive any information of concern from them. We also requested details from the provider in advance of the inspection. 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 principal dentist (who was the registered manager), two dentists and three nurses and one receptionist. We also spoke with patients and reviewed CQC comment cards which patients had completed. We reviewed a range of practice policies and protocols and other records relating to the management of the service.

Approximately 30% of dental care provided at this practice was NHS. The remainder was private (both private scheme insurance and fee per item).

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 25 February 2016

We carried out an announced comprehensive inspection on 5 October 2015 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

Robinson & Dicker Dental Practice provides general dental services for NHS and private patients. The service is provided by the practice owner (principal dentist), three associate dentists, one therapist and two hygienists. They are supported by eight nurses (one of whom is a trainee) and three receptionists (two of whom are trainees). Another dentist visits the practice on an ad hoc basis to provide implants (approximately on a monthly basis). This dentist (implantologist) brings their own nurse who has received additional training to assist with implant surgery. This dentist occasionally carries out conscious sedation – this is restricted to their own patients who are undergoing implant surgery. (Conscious sedation involves techniques in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation). The provider also carries out some adult orthodontic treatment on a private basis.

The practice is located within a converted three storey building on a busy road in Erdington. There is wheelchair access available to the premises with a designated parking bay by the entrance. There is disabled access to the ground floor waiting area and the ground floor treatment room offers access for patients with reduced mobility. The practice is located close to local amenities and bus services. One of the dentists offers domiciliary care for those patients who cannot access the practice. Opening hours are Monday to Friday 8:45am to 5pm.

The practice owner (Dr Jain) is the registered manager. Dr Jain became the practice owner in August 2015 i.e. two months prior to this inspection. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

23 patients provided feedback about the practice. We looked at comment cards patients had completed prior to the inspection and we also spoke with patients on the day of the inspection. Overall the information from patients was very positive. Patients were positive about their experience and they commented that they were treated with care, respect and dignity. They commented that the dentists were very knowledgeable and always listened to patients. Staff told us that they always interacted with them in a respectful, appropriate and kind manner.

Our key findings were:

• Systems were in place to assess and manage risks to patients, including infection prevention and control, health and safety, safeguarding and the management of medical emergencies.
• Oral health advice and treatment were provided in line with the ‘Delivering Better Oral Health’ toolkit.
• Patients told us they were treated with care, respect and dignity. Patients commented they felt involved in their treatment and that it was fully explained to them.
• There were clearly defined leadership roles within the practice and staff told us they felt supported and comfortable to raise concerns or make suggestions.
• Patients were able to make routine and emergency appointments when needed.
• The practice had an effective complaints system in place and there was an openness and transparency in how these were managed.
• Audits in key areas (X-rays, dental care records and infection control) were overdue.

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

• Implement a system so that the practice conducts regular audits to help improve the quality of the service (evidence of this was provided after the inspection visit).
• Adopt a robust recruitment process so that accurate, complete and detailed records are maintained relating to employment of staff. This includes making appropriate notes of verbal references taken and ensuring recruitment checks, including references and immunisation status, are suitably obtained and recorded. Staff appraisals should be regularly conducted.

• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping. This includes recording consent for dental care and treatment.
• Consider a more robust process for documenting all incidents and details relating to health and safety such as testing fire alarms and decontamination equipment.