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Inspection Summary


Overall summary & rating

Updated 13 April 2017

We carried out an announced comprehensive inspection on 13 March 2017 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

Lyndhurst Dental Practice is a dental practice providing mainly private treatment and was established in 1975.

The practice is situated in a large detached Victorian villa occupying the ground floor and lower ground floor. Level disabled access is to the ground floor where there is one surgery. There is an external stairway to the lower ground floor where there are a further four surgeries. Off street parking is available and there are local bus and train links.

The practice employs four dentists, four dental hygienists, seven dental nurses and three reception staff. There were also staff employed for property maintenance, maintaining accounts and an administration assistant.

Several dentists have enhanced skills and provide more complex treatments such as dental implants, specialized gum treatments and complex root canal treatments.

The practice opens: Monday to Friday 8am 1pm and 2pm - 5.30pm. Saturday: Closed, Sunday: Closed.

There are arrangements in place to ensure patients receive urgent dental assistance when the practice is closed. If patients called the practice when it was closed, an answerphone message gives the telephone number patients should ring depending on their symptoms.

One of the principal dentists 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.

The inspection was carried out by a lead inspector and a dental specialist adviser.

Before the inspection, we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 44 patients. In addition we spoke with two patients on the day of our inspection. Feedback from patients was positive about the quality of care, the caring nature of all staff and the overall high quality of customer care. They commented that staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained them so they could make an informed decision which gave them confidence in the care provided.

Our key findings were:

  • We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
  • Effective leadership was provided by the principal dentists.
  • Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
  • The practice appeared clean and well maintained.
  • Infection control procedures were effective and the practice followed published guidance.
  • The practice had effective processes in place for safeguarding adults and children living in vulnerable circumstances.
  • There was a policy and procedure in place for recording adverse incidents and accidents.
  • The dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
  • The service was aware of the needs of the local population and took these into account in how the practice was run.
  • Patients could access treatment and urgent and emergency care when required.
  • Staff had received training appropriate to their roles and were supported in their continued professional development (CPD) by the principal dentists.
  • Staff we spoke with felt well supported by the principal dentists and were committed to providing a quality service to their patients.

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

  • Review the dispensing protocols for the antibiotic amoxycillin in line with dispensing guidelines issued by the British Pharmacology Society.
Inspection areas

Safe

No action required

Updated 13 April 2017

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

The practice had effective arrangements in place for infection control, clinical waste control, management of medical emergencies at the practice and dental radiography (X-rays).

We found that all the equipment used in the dental practice was properly maintained. The practice took their responsibilities for patient safety seriously and staff were aware of the importance of identifying, investigating and learning from patient safety incidents.

Staff received safeguarding training and were aware of their responsibilities regarding safeguarding children and vulnerable adults.

The practice carried out and reviewed risk assessments to identify and manage risks.

There were clear procedures regarding the maintenance of equipment and the storage of medicines in order to deliver care safely and in an emergency.        

Effective

No action required

Updated 13 April 2017

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

The dental care provided was evidence based and focused on the needs of the patients. The practice used current national professional guidance including that from the National Institute for Health and Care Excellence (NICE) to guide their practice.

We saw examples of positive teamwork within the practice and evidence of good communication with other dental professionals.

The staff received professional training and development appropriate to their roles and learning needs.

Staff where appropriate were registered with the General Dental Council (GDC) and were meeting the requirements of their professional registration.

The practice held electronic and paper records of the care given to patients including comprehensive information about patients’ oral health assessments, treatment and advice given. Records seen showed patients were recalled in line with national guidance and screened appropriately for gum disease and oral cancer.

They monitored any changes in the patient’s oral health and made referrals as appropriate to other primary and secondary care providers such as for specialist orthodontic treatment or hospital services for further investigations or treatment as required.

The practice was proactive in providing patients with advice about preventative care and supported patients to ensure better oral health in line with Public Health England publication ‘Delivering better Oral Health 3rd edition. (DBOH).

Caring

No action required

Updated 13 April 2017

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

We reviewed 44 completed CQC comments and received feedback on the day of the inspection from two patients about the care and treatment they received at the practice.

Patients commented the quality of care was very good. Patients commented on the friendliness and helpfulness of the staff and told us dentists were good at explaining the treatment that was proposed.

We observed privacy and confidentiality were maintained for patients using the service on the day of the inspection. Policies and procedures in relation to data protection and security and confidentiality were in place and staff were aware of these.

Responsive

No action required

Updated 13 April 2017

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

Patients could access treatment and urgent and emergency care when required.

The practice provided patients with written information and had developed a practice information pack.

The practice had experienced very few requests for treatment by patients whose first language was not English but provided patients with written information in a language they could understand and had access to telephone interpreter services if required.

The practice had carried out an access assessment and patients who had mobility difficulties or used a wheelchair, could be treated in the surgery at ground floor level which was fully accessible. although they may have required some assistance to negotiate the entrance door.

There was a portable hearing loop available, information and forms were available and could be printed in large print when required.

There was a procedure in place for acknowledging, recording, investigating and responding to complaints and concerns made by patients or their carers.

Well-led

No action required

Updated 13 April 2017

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

We found effective leadership was provided by the principal dentists. Staff had an open approach to their work and shared a commitment to continually improving the service they provided. There was a no blame culture in the practice.

The practice maintained a comprehensive system of policies and procedures using a commercially available dental clinical governance system which had been recently introduced by the principal dentists. The same company also carried out a range of compliance audits.

Policies and procedures were reviewed on a regular basis although we found that some information needed to be updated.

Staff told us they felt well supported and could raise any concerns with the principal dentists and colleagues. All the staff we met said they were happy in their work and had clearly defined roles within the practice.

The practice assessed risks to patients and staff and carried out a programme of audits as part of a system of continuous improvement and learning, although we noted that the audit for infection control was last carried out in January 2016.

The practice had systems in place to seek and act upon feedback from patients using the service.