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Inspection Summary


Overall summary & rating

Updated 21 November 2018

We carried out this announced inspection on 17 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 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

TLC Dental Limited is near the centre of Poynton and provides private dental care and treatment for adults and children.

The practice is accessed by a flight of stairs. Car parking is available at the practice.

The dental team includes the principal dentist, three dental nurses, two of whom also carry out reception duties, and a receptionist. The practice has one treatment room.

The practice is owned by a company 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 TLC Dental Limited was the principal dentist.

We received feedback from nine people during the inspection about the services provided. The feedback provided was positive.

During the inspection we spoke to the dentist and two dental nurses. 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 9.00am to 5.00pm

Thursday 8.30am to 5.00pm.

Our key findings were:

  • The practice was clean and well maintained.
  • The practice had infection control procedures in place which reflected published guidance.
  • Staff knew how to deal with medical emergencies. Appropriate medicines and equipment were available, with the exception of one medical emergency medicine which was not the recommended medicine.
  • The provider had systems in place to manage risk.
  • The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
  • The provider had staff recruitment procedures in place.
  • Staff provided patients’ care and treatment in line with current guidelines. The provider did not fully adhere to the guidelines on domiciliary care when providing dental care for people in care homes and their own homes.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • The dental team provided preventive care and supported patients to achieve better oral health.
  • The appointment system took account of patients’ needs.
  • The provider had a procedure in place for dealing with complaints. The practice dealt with complaints positively and efficiently.
  • The practice had a leadership and management structure and a culture of continuous improvement.
  • Staff felt involved and supported and worked well as a team.
  • The practice asked patients and staff for feedback about the services they provided.
  • The provider had information governance arrangements in place.

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

  • Review the availability of medicines, specifically buccal midazolam, in the practice to manage medical emergencies taking into account the guidelines issued by the British National Formulary and the General Dental Council.
  • 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”.
Inspection areas

Safe

No action required

Updated 21 November 2018

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

The provider had systems and processes in place to provide safe care and treatment.

Staff received training in safeguarding and knew how to report concerns.

Staff were qualified for their roles, where relevant.

The provider completed essential recruitment checks before employing staff.

The premises and equipment were clean and properly maintained. The practice followed national guidance for cleaning, sterilising and storing dental instruments.

The practice had suitable arrangements for dealing with medical and other emergencies. One of the medical emergency medicines was not the recommended one. The provider assured us this would be addressed.

The practice had systems in place for the safe use of X-rays.

Effective

No action required

Updated 21 November 2018

We found that this practice was providing effective care in accordance with

the relevant regulations.

The dentist assessed patients’ needs and provided care and treatment in line with recognised guidance. Patients described the treatment they received as thorough and first class

. The dentist discussed treatment with patients so they could give informed consent and recorded this in their records.

The dentist did not adhere fully to recognised guidance when providing dental care in the patient’s home or for people in care homes. The provider assured us this would be reviewed.

The practice had clear arrangements for referring patients to other dental or health care professionals.

The provider supported staff to complete training relevant to their roles and had systems to monitor this.

The provider had systems in place in relation to the safe provision of sedation and followed recognised guidance.

Caring

No action required

Updated 21 November 2018

We found that this practice was providing caring services in accordance with

the relevant regulations.

We received feedback about the practice from nine people. Patients were positive about all aspects of the service the practice provided. They told us staff were professional, friendly and efficient and said their dentist listened to them.

Patients commented that staff made them feel at ease, especially when they were anxious about visiting the dentist.

Staff protected patients’ privacy and were aware of the importance of confidentiality.

Patients said staff treated them with dignity and respect.

Responsive

No action required

Updated 21 November 2018

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

The practice’s appointment system took account of patients’ needs. Patients could book an appointment quickly if in pain.

Staff considered patients’ differing needs and put measures in place to help all patients receive care and treatment. This included providing facilities for patients with disabilities and families with children. The practice had access to interpreter services and had arrangements to assist patients who had sight or hearing loss.

The practice offered dental care to patients in their own homes and to people in care homes. A limited range of treatment was available.

The practice took patients views seriously. They valued compliments from patients and responded to concerns and complaints quickly and constructively.

Well-led

No action required

Updated 21 November 2018

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

The provider had arrangements in place to ensure the smooth running of the service and to sustain this in the longer term. These included systems for the practice team to monitor the quality and safety of the care and treatment provided.

The practice leader was approachable and staff felt supported and appreciated.

The practice team kept accurate, complete patient dental care records which were stored securely.

Staff monitored clinical and non-clinical areas of their work to help them improve and learn. This included auditing their procedures and asking for and listening to the views of patients and staff.

The provider had procedures in place to manage and reduce risks.