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Inspection Summary


Overall summary & rating

Updated 6 September 2016

We carried out an announced comprehensive inspection on 11 August 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 after immediate action was taken as a result of this inspection. Detailed feedback was given to the practice during and following the inspection and this resulted in a comprehensive action plan being developed and acted upon within a short timescale to address the concerns.

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

543 Dental Centre Limited is situated in the city of Hull, Humberside. The practice offers NHS and private dental treatments including preventative advice, domiciliary home visits, dental implants, endodontics, cosmetic dental treatment, orthodontics, conscious sedation and oral surgery.

The practice has 13 surgeries over two floors, a decontamination room connected by a hatch to a sterilisation room, six waiting areas, one oral health prevention room; four areas for the four Orthopantomogram (OPT) machines, a reception area to welcome patients and a separate area for patients to make further appointments and patient toilets on each floor. All facilities are located over three floors of the premises. There are staff facilities and offices on the second floor of the premises.

There are two managing directors, 12 dentists (including a foundation dentist, the clinical director and the chairman and a specialist Oral surgeon), two dental hygiene therapists, 22 dental nurses (one of which is a trainee and one is the practice manager), a treatment co-ordinator, nine receptionists (one of which is the head receptionist and two are deputy practice managers), two infection control support staff, two admin staff and three domestic support assistants.

The practice is open between the hours of 8am and 7pm; opening and closing hours varying from day to day throughout the week and the practice is open 9am – 12 noon on a Saturday for private patients and dental emergencies.

The practice manager is the registered manager. 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 in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
  • The practice appeared clean and hygienic.
  • There were sufficient numbers of suitably qualified staff to meet the needs of patients.
  • Infection control procedures were in accordance with the published guidelines.
  • Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
  • Treatment was well planned and provided in line with current best practice guidelines.
  • Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
  • Patients were treated with dignity and respect and confidentiality was maintained.
  • The appointment system met patients’ needs.
  • The practice was well-led and staff felt involved and supported and worked well as a team.
  • The governance systems were effective.
  • The practice sought feedback from staff and patients about the services they provided.
  • There were clearly defined leadership roles within the practice.

We found areas of notable practice that we felt should be shared including establishing a charity to support each school in the Hull area which included working with local schools to raise awareness of oral health and provide preventative fluoride treatments. This was also being adapted throughout areas within the north of England.

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

  • Review the practice's recruitment policy to ensure procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
  • Review the practice’s protocols for domiciliary visits; taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
  • Review the safe storage of clinical waste and ensure this is locked and secured outside the premises.
Inspection areas

Safe

No action required

Updated 6 September 2016

We found that this practice was providing safe care in accordance with the relevant regulations after immediate action was taken as a result of this inspection. Detailed feedback was given to the practice during and following the inspection and this resulted in a comprehensive action plan being developed and acted upon within a short timescale to address the concerns.

There was inconsistent evidence of staff being appropriately recruited and suitably trained and skilled to meet patients’ needs. There were sufficient numbers of staff available at all times. Staff induction processes were in place but had not been completed by all staff. We reviewed two of the newest member of staff’s induction file and no evidence was available to show that policy and process had been followed.

The practice had effective systems and processes in place to ensure all care and treatment was carried out safely. For example, there were systems in place for infection prevention and control, clinical waste control, dental radiography and management of medical emergencies. All emergency medicines were in date and in accordance with the British National Formulary (BNF) and Resuscitation Council UK guidelines.

Staff told us they felt confident about reporting incidents, accidents and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).

Staff had received training in safeguarding patients and knew how to recognise the signs of abuse and who to report them to including external agencies such as the local authority safeguarding team.

The decontamination procedures were effective and the equipment involved in the decontamination process was regularly serviced, validated and checked to ensure it was safe to use.

We reviewed the legionella risk assessment dated July 2016 and evidence of regular water testing being carried out in accordance with the assessment.

Effective

No action required

Updated 6 September 2016

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

Patients’ dental care records provided comprehensive information about their current dental needs and past treatment. The practice monitored any changes to the patient’s oral health and made in house referrals for specialist treatment or investigations where indicated.

The practice followed best practice guidelines when delivering dental care. These included Faculty of General Dental Practice (FGDP), National Institute for Health and Care Excellence (NICE), guidance from the British Orthodontic Society (BOS), Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) and guidance from the British Society of Periodontology (BSP).

Staff were encouraged and supported to complete training relevant to their roles and this was monitored by the practice manager. The clinical staff were up to date with their continuing professional development (CPD).

The practice liaised with the external referring practitioners effectively to keep them informed of treatment decisions which had been made and also any after care which would be required.

Caring

No action required

Updated 6 September 2016

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

Comments on the 13 completed CQC comment cards we received showed the patients were very positive about the care and treatment they received at the practice. Comments included that the staff were friendly, caring and professional. Patients also commented that they were heavily involved in treatment options and had a treatment co-ordinator allocated to them to help them through their patient journey. All discussions including the associated costs were explained thoroughly.

We observed patients being treated with respect and dignity during interactions at the reception desk, over the telephone and as they were escorted through the practice. Privacy and confidentiality were maintained for patients using the service on the day of the inspection. We also observed staff to be welcoming and caring towards the patients.

Responsive

No action required

Updated 6 September 2016

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

The practice had an efficient appointment system in place to respond to patients’ needs. Any patients requesting an emergency appointment would be seen the same day. The practice had a direct number for any dental emergencies or dental pain patients

Patients commented they could access treatment for urgent and emergency care when required. There were clear instructions for patients requiring urgent care when the practice was closed.

There was a procedure in place for responding to patients’ complaints. This involved acknowledging, investigating and responding to individual complaints or concerns. Staff were familiar with the complaints procedure.

The practice had good access for patients with limited mobility at the rear of the practice with a permanent ramp and at the front of the practice where it was step free access. Disabled parking places were available to the rear of the practice and six surgeries were accessible on the ground floor to accommodate patient’s needs. Reasonable adjustments had been made to the practice where possible including hand rails on the stairs and toilets with hand rails and alarms. Medical emergency oxygen was also available in the ground floor toilets and locked for safety.

Well-led

No action required

Updated 6 September 2016

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

There was a clearly defined management structure in place and all staff felt supported and appreciated in their own particular roles. The managing directors, clinical director and practice manager were responsible for the day to day running of the practice.

The practice regularly audited clinical and non-clinical areas as part of a system of continuous improvement and learning.

The practice conducted extensive patient satisfaction surveys, collected patient testimonials and collated feedback from Facebook and twitter. There was also a comments box in the waiting room for patients to make suggestions to the practice and I-pad to gather any comments and also patients were sent emails after treatment was completed to also provide feedback.

Staff were encouraged to share ideas and feedback as part of their appraisals and personal development plans. All staff were supported and encouraged to improve their skills through learning and development.

The practice held quarterly staff meetings which were minuted and gave everybody an opportunity to openly share information and discuss any concerns or issues. The dentists also had monthly meetings to discuss clinical cases or results of clinical audits.