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Inspection Summary


Overall summary & rating

Updated 22 November 2018

We carried out this announced inspection on 23 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

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 form the framework for the areas we look at during the inspection.

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

InDental Orthodontics is in Gateshead, Tyne and Wear and provides NHS and private orthodontic treatment to adults and children.

InDental Orthodontics occupies the first floor of a purpose-built premises; it’s sister practice InDental practice is on the ground floor. There is level access for people who use wheelchairs and those with pushchairs. A lift is available for patients. Car parking spaces are present near the practice.

The dental team includes a specialist orthodontist, a dentist with special interests in orthodontics, a practice manager, an orthodontic therapist, three dental nurses, two decontamination assistants and a receptionist. The practice has two treatment rooms all on the first floor.

The practice is owned by a partnership 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. The registered manager at InDental Orthodontics was the practice manager.

On the day of inspection, we collected 15 CQC comment cards filled in by patients.

During the inspection we spoke with a dentist with special interests in orthodontics, two dental nurses, one decontamination assistant, an orthodontic therapist, the receptionist and the practice manager.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday, Wednesday and Friday 8am to 5pm

Thursday 8am to 4pm

Our key findings were:

  • The practice appeared clean and well maintained.
  • The practice had infection control procedures in place; these did not reflect published guidance in relation to temperature monitoring of manual decontamination procedures and gypsum clinical waste disposal.
  • Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
  • The provider had systems to help them manage risk. These systems were not always effectively monitored.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The provider had staff recruitment procedures. These required reviewing, in particular for carrying out Disclosure and Barring service checks.
  • The clinical staff provided patients’ care and treatment in line with current guidelines.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information. The practice had closed-circuit television (CCTV) on the premises. The practice’s CCTV protocols did not follow national guidance.
  • The practice provides preventive care and support to patients to ensure better oral health.
  • The appointment system met patients’ needs.
  • The practice leadership could be improved.
  • The practice had suitable information governance arrangements.
  • Staff felt involved and supported and worked well as a team.
  • The practice asked staff and patients for feedback about the services they provided.
  • The practice dealt with complaints positively and efficiently.
  • The monitoring of dental nurses’ training and development could be more robust, for example, by introducing an appraisal system.
  • Significant events and incidents were not logged.

We identified an area of notable practice.

  • The practice holds a patient forum every six months. Patients are invited to the practice one evening, are provided with refreshments and asked for five positive and five negative aspects of their experience at the dental practice. The results are then analysed and, where appropriate, changes are implemented into practice. The Department of Health invited the practice manager to events to discuss the practice forum as an exemplary to other practices. We believe this is notable because it shows the provider values patients’ opinions, welcomes compliments from patients and responds to concerns or recommendations constructively.

There were areas where the provider could make improvements. They should:

  • Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
  • Review the practice’s protocols for the use of closed-circuit television taking into account the guidelines published by the Information Commissioner's Office.

  • Review the practice’s risk management systems to ensure risk assessments are carried out for all hazardous substances identified by the Control of Substances Hazardous to Health Regulations 2002, and for all other risks identified on-site.
  • Review the practice’s infection control and waste disposal procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
  • Review the practice’s referral protocols to ensure all referrals are monitored appropriately.
Inspection areas

Safe

No action required

Updated 22 November 2018

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

The practice had systems and processes to provide safe care and treatment.

They used complaints to help them improve. There was no system in place to record significant events or incidents that had occurred at the practice.

Staff received training in safeguarding and knew how to recognise the signs of abuse and how to report concerns.

The provider completed essential recruitment checks for employees apart from a DBS check for one member of clinical staff. A risk assessment was not in place to mitigate the risk of working without a DBS check. This was sent to us the following day. Staff were qualified for their roles.

Premises and equipment were clean and properly maintained. The practice did not follow national guidance for monitoring the temperature of cleaning solutions for manual decontamination procedures and disposal of gypsum waste.

The practice had suitable arrangements for dealing with medical and other emergencies.

The provider did not manage all risks identified on-site. For example, they did not assess the risk to clinical employees whose immune status to Hepatitis B was unknown.

Effective

No action required

Updated 22 November 2018

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

The orthodontic dental professionals assessed patients’ needs and provided care and treatment in line with recognised guidance. Patients described the treatment they received as professional and excellent. The orthodontic dental professionals discussed treatment with patients so they could give informed consent and recorded this in their records.

The practice had clear arrangements when patients needed to be referred to other dental or health care professionals. Referrals were not monitored to ensure they were dealt with in a timely manner and appropriately.

The practice supported staff to complete training relevant to their roles. The monitoring of dental nurses’ training and development could be more robust, for example, by introducing an appraisal system.

The staff were involved in quality improvement initiatives and peer review with other dental professionals as part of its approach in providing high quality care.

Caring

No action required

Updated 22 November 2018

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

We received feedback about the practice from 15 people. Patients were positive about all aspects of the service the practice provided. They told us staff were patient, caring and highly attentive to their needs.

They said that they were given helpful, honest explanations about dental treatment and said their dentist listened to them. Patients commented that they made them feel at ease, especially when they were anxious about visiting the dentist.

We saw that staff protected patients’ privacy and were aware of the importance of confidentiality. A CCTV system was in operation - appropriate signs were not displayed to notify people of this. There was no CCTV policy and a privacy impact assessment had not been completed in line with the General Data Protection Regulation (GDPR) requirements.

Patients said staff treated them with dignity and respect.

Responsive

No action required

Updated 22 November 2018

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

The practice’s appointment system was efficient and met patients’ needs. Patients could get an appointment quickly if in pain.

Staff considered patients’ different needs. This included providing facilities for disabled patients and families with children. The practice had access to interpreter services and had arrangements to help patients with sight or hearing loss.

The practice took patients views seriously.

Well-led

No action required

Updated 22 November 2018

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

The systems to manage risks and discuss the safety of the care and treatment provided could be improved.

There was a defined management structure and staff felt supported and appreciated. The practice manager was very responsive on the inspection day and took prompt action to rectify shortcomings where possible.

The practice team kept patient dental care records which were clearly typed and stored securely.

The practice monitored clinical and non-clinical areas of their work to help them improve and learn. This included asking for and listening to the views of patients and staff. The practice took patients views seriously; a patient forum was set up to specifically discuss these.