Twickel Dental Limited

Updated 5 November 2015

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 carried out an announced, comprehensive inspection on 17 September 2015 by a CQC inspector and a dentist specialist advisor. Before the inspection we reviewed information we held about the provider and information that we asked them to send us in advance of the inspection. During our inspection visit, we reviewed a range of policies and procedures and other documents including dental care records. We spoke with four members of staff, including the management team. We looked around the premises including the treatment rooms. We looked at the storage arrangements for emergency medicines and equipment. We observed the dental nurse carrying out decontamination procedures of dental instruments and also observed staff interacting with patients in the waiting area.

We reviewed 14 Care Quality Commission (CQC) comment cards completed by patients and reviews posted on the NHS Choices website. Patients gave positive views about the care and experience of the practice. 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 5 November 2015

We carried out an announced comprehensive inspection on 17 September 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.

Twickel Dental Limited provide NHS and private dental treatment and the majority of patients at the practice are NHS. The practice is situated in a rural area of Shropshire, Much Wenlock. The majority of the population (44.6%) who receive a service from Twickel Dental Limited are aged 55 years or older, with 35.4% of the practice patients being of working age and 20% were children. Twickel Dental Limited has a principal dentist who works between four and five days per week and a dental associate who works five days per week. The practice team includes a dental hygienist who works on a Friday each week and four dental nurses. One of the dental nurses primarily works in a receptionist/practice manager role.

Twickel Dental Limited practice premises had been subject to recent refurbishment. The treatment room surgeries are fully equipped and the reception area is now separated from the waiting room to enable further patient privacy. The reception area and waiting room are on the ground floor. The main entrance to reception has a couple of steps that patients with restricted mobility are aware of. The practice has a separate side door entrance which patients with restricted mobility can use to access the service. The practice has two dental treatment rooms. These rooms contain spacious areas for the decontamination and cleaning, sterilising and packing of dental instruments.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to use to tell us about their experience of the practice. We collected 14 completed cards and spoke with two patients. These provided a positive view of the service the practice provides. Patients told us the practice was welcoming and that the dentist was understanding, thorough and helpful. Several patients specifically commented that the dentist put them at ease. We spoke with four staff members all were particularly good at understanding the needs of people living with dementia illnesses and those with learning disabilities. They understood their responsibilities under the Mental Capacity Act (2005).

The practice is part of the British Dental Association Good Practice scheme. The business is operated by a private limited company which has one director who is also the registered manager with CQC. 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.

Our key findings were:

• The practice had systems for dealing with significant events and accidents and staff understood their responsibilities for providing a safe service.
• The practice was visibly clean and had processes to help staff manage infection prevention and control effectively.
• The practice had systems, medicines and equipment for the management of medical emergencies and staff were trained to know how to deal with these.
• The practice had safeguarding processes and staff understood their responsibilities for safeguarding adults and children.
• Clinical records included the essential information expected about patients’ care and treatment including treatment plans and consent to care and treatment.
• The practice was committed to staff education and development. Staff received training appropriate to their roles and were encouraged and supported in their continued professional development (CPD).
• The practice had received one complaint in eight years and had a clear system for handling and responding to complaints.
• Patients who completed Care Quality Commission comment cards were pleased with the care and treatment they or their family member received and were complimentary about the whole practice team.
• The practice had well organised governance and leadership arrangements and an open door policy which made staff feel valued and listened to with few exceptions. The exception were for example, a lack of management oversight on staff training to be assured that all staff were up to date with their training needs and a lone working policy.
• The practice had open and supportive leadership and staff were happy in their roles, professional and enthusiastic.

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

• Ensure necessary employment checks are in place for all staff and records held of the required specified information in respect of persons employed by the practice in line with Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Consider further detail on the health promotion advice given and verbal consents within the patient records.
• Further improve the security of prescription pads in line with NHS Protect guidelines.
• Formalise the practice induction training and ensure staff receive appropriate training in Health and Safety and ensure regular fire awareness training for staff employed at the practice.
• Ensure documentation and risk assessments are in place when informed by suppliers that a particular medicine for emergencies in no longer available.
• Consider a lone working policy.