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Inspection Summary


Overall summary & rating

Updated 6 October 2016

We carried out an announced comprehensive inspection on 9 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.

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

Argo Dental Practice has four dentists who work part time, two dental hygienists and one dental therapist, two qualified dental nurses who are registered with the General Dental Council (GDC) and two apprentice dental nurses, a practice manager, and two receptionists. The practice’s opening hours are 9am to 5pm on Monday, 8am to 5pm on Tuesday and Friday, 8am to 6pm Wednesday and 8am to 8pm on a Thursday.

Argo Dental Practice provides private dental treatment for adults and children. The practice has four dental treatment rooms on the ground floor and a separate decontamination room for cleaning, sterilising and packing dental instruments. There was also a reception and waiting area.

The registered manager was present during 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.

Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received feedback from ten patients who provided an overwhelmingly positive view of the services the practice provides. All of the patients commented that the quality of care was good.

Our key findings were

  • There were sufficient numbers of suitably qualified staff to meet the needs of patients.
  • Feedback from patients was positive. Patients said they were treated with dignity and respect.
  • The practice was visibly clean and well maintained.
  • Infection control procedures were in place with infection prevention and control audits being undertaken on a six monthly basis. Staff had access to personal protective equipment such as gloves and aprons.
  • There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
  • Patients’ confidentiality was maintained.
  • Dentists identified treatment options and these were discussed with patients.
  • There was a whistleblowing policy accessible to all staff, who were aware of procedures to follow if they had any concerns.
  • Staff had been trained to deal with medical emergencies, although update training was required which had been booked for September 2016.
  • The appointment system met the needs of patients and waiting times were kept to a minimum.
  • Governance arrangements were in place for the smooth running of the practice and there was a structured plan in place to audit quality and safety beyond the mandatory audits for infection control and radiography.

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

  • Review the practice’s policy and procedures for accident reporting and develop a policy in relation to duty of Candour.

  • Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
  • Review availability of staff training to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
  • Review the suitability of the decontamination room in relation to the availability of separate hand wash facilities.
  • Review the practice’s risk assessment processes.
  • Review the current legionella risk assessment and implement the required actions.
  • Review compliance with the legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
  • Review the practice’s audit protocols of various aspects of the service and ensure audits have documented learning points and the resulting improvements can be demonstrated.
Inspection areas

Safe

No action required

Updated 6 October 2016

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

Staff were aware of the procedure to follow to report incidents, accidents and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).

Staff had received training in safeguarding vulnerable adults and children. Staff knew how to recognise signs of abuse and how to raise concerns. Staff were aware who held the lead role to offer support regarding safeguarding matters.

Medicines for use in an emergency were available on the premises as detailed in the Guidance on Emergency Medicines set out in the British National Formulary (BNF). However, changes were required to the dosage strength of aspirin available which we were told would be addressed immediately. Emergency medical equipment was also available and documentation was available to demonstrate that checks were being made to ensure equipment was in good working order and medicines were within their expiry date.

Staff had received training in responding to a medical emergency although update training was overdue for some staff. This training had been booked for September 2016.

The practice did not receive Medicines and Healthcare products Regulatory Agency (MHRA) alerts, however the registered manager confirmed that they would register to receive this information immediately.

Infection control audits were being undertaken on a six monthly basis in line with the recommendations of HTM 01-05. The practice had systems in place for waste disposal and on the day of inspection the practice was visibly clean and clutter free.

Effective

No action required

Updated 6 October 2016

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

Patients were assessed by a dental professional before treatment began. Patients and staff told us that explanations about treatment options and oral health were given to patients in a way they understood and risks, benefits, options and costs were explained. Patients’ dental care records confirmed this. The dental care provided was evidence based and focussed 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. The practice used oral screening tools to identify oral disease.

There were clear procedures for referring patients to secondary care (hospital or other dental professionals). Referrals were made in a timely way to ensure patients’ oral health did not suffer.

Staff received professional training and development appropriate to their roles and learning needs. Staff were registered with the General Dental Council (GDC) and were meeting the requirements of their professional registration.

Caring

No action required

Updated 6 October 2016

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

Privacy and confidentiality were maintained for patients using the service on the day of the inspection. Staff treated patients with kindness and respect and were aware of the importance of confidentiality. Feedback from patients was overwhelmingly positive. Patients commented that staff were professional, friendly and helpful.

Responsive

No action required

Updated 6 October 2016

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

The practice had ground floor treatment rooms and toilet which had been adapted to meet the needs of patients with a disability. However contact details for an external agency that could provide assistance with communication via British Sign Language were not available on the day of inspection, although we were told that this information would be sourced immediately.

The practice had developed a complaints procedure and information about how to make a complaint was available for patients to reference.

Well-led

No action required

Updated 6 October 2016

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

There was a clear management structure at the practice. Staff were aware of their roles and responsibilities within the dental team, and knew who to speak with if they had any concerns.

Regular staff meetings were held and systems were in place to ensure all staff who were unable to attend the meeting received an update about topics of discussion. However the minutes of meetings we saw did not record detailed information regarding topics of discussion. Minutes of meetings did not demonstrate, for example, that accidents, incidents, complaints, patient feedback or audits and the learning points from these had been discussed with staff.

Policies and procedures were available to staff to help the smooth running of the practice, however there was no duty of candour policy

Annual appraisal meetings took place and staff said that they were encouraged to undertake training to maintain their professional development skills. Staff told us the provider was very approachable and supportive and the culture within the practice was open and transparent.