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Inspection Summary


Overall summary & rating

Updated 1 January 2018

We carried out this announced inspection on 20 November 2017 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

Green Square Dental Limited is in Rotherham and provides private treatment to adults and children, which includes dental implants, intravenous sedation, restorative and cosmetic dentistry.

There is ramp access for people who use wheelchairs and pushchairs. Car parking spaces, including one space for patients with disabled badges, are available at the practice.

The dental team includes the principal dentist, a practice manager, three dental nurses (one of which is a trainee) and a dental hygienist.

The practice has two surgeries; a dedicated room for taking cone beam computed tomography (CBCT) scans, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office.

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 Green Square Dental Limited was the principal dentist.

On the day of inspection we collected 20 CQC comment cards filled in by patients and spoke with one patient. This information gave us a very positive view of the practice.

During the inspection we spoke with the principal dentist, one dental nurse 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 9am - 7:30pm, Tuesday 12:30pm - 7:30pm, Wednesday 9am – 5:30pm.

Thursday 9am – 5pm, Friday and Saturday 8:30am – 13:30pm.

Our key findings were:

  • The practice was clean and well maintained.
  • The practice had infection control procedures which reflected published guidance. We identified some areas where improvements could be made.
  • Staff knew how to deal with emergencies. Appropriate medicines were available; some life-saving equipment was not present.
  • The practice had systems to help them manage risk. A comprehensive Legionella risk assessment was required.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The practice had thorough staff recruitment procedures.
  • 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.
  • We identified an area for improvement in relation to the use of Cone Beam CT (Computed Tomography) equipment.
  • The appointment system met patients’ needs.
  • The practice had effective leadership. 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.

We identified an areas of notable practice:

  • The practice was engaged with the local community and The Department for Work and Pensions (DWP) to offer temporary work placements for disadvantaged individuals and those with physical impairment who were finding it difficult to get into work or get a work experience.

    For example, an individual with dyslexia came to work at the practice over a four week placement with a coach who assisted them during the placement. They worked in the waiting room keeping it tidy and clean.

  • The practice also worked in association with a local children’s hospice offering emergency dental appointments to the families who were staying with their ill child at the hospice.

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

  • Review the practice procedures and take into account HPA-CRCE-010 Guidance on the Safe Use of Dental Cone Beam CT (Computed Tomography) Equipment in having quality assurance measures for the use of the Cone Beam Computed Tomography scanner (CBCT). Produce a policy to support its use and include CBCT into local rules for radiography.
Inspection areas

Safe

No action required

Updated 1 January 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 learning from incidents and complaints to help them improve.

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

The practice had not signed up to receive Medical Healthcare Regulatory Authority (MHRA) alerts on the day of inspection. We saw that this was achieved after the inspection.

Staff were qualified for their roles and the practice completed essential recruitment checks.

The practice was clean and properly maintained.

The practice followed national guidance for cleaning, sterilising and storing dental instruments.

We identified areas for improvement in relation to equipment validation and infection prevention and control quality assurance. We were sent evidence that the improvements were fully achieved after the inspection.

An in-house Legionella risk assessment had been carried out. We highlighted to the principal dentist that this was not in line with recommended guidance. We were sent evidence that arrangements had been made immediately after the inspection for a comprehensive legionella risk assessment to take place.

We identified that improvements could be made to the quality auditing process in relation to the CBCT equipment. A CBCT is an X-ray based imaging technique which provides high resolution visualisation of bony anatomical structures in three dimensions.

The practice had suitable arrangements for dealing with medical and other emergencies. Some medical emergency equipment was missing on the inspection day. These items were sourced and in place the following day, evidence was sent to us to support this.

Effective

No action required

Updated 1 January 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 fantastic, excellent and exceptional.

The dentist 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.

The practice supported staff to complete training relevant to their roles and had systems to help them monitor this.

Caring

No action required

Updated 1 January 2018

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

We received feedback about the practice from 21 people. Patients were positive about all aspects of the service the practice provided. They told us staff were very friendly, welcoming and caring. 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. Patients said staff treated them with dignity and respect.

Responsive

No action required

Updated 1 January 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 telephone or face to face interpreter services and had arrangements to help patients with sight or hearing loss.

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 1 January 2018

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

The practice had arrangements to ensure the smooth running of the service. These included systems for the practice team to discuss the quality and safety of the care and treatment provided. There was a clearly defined management structure and staff felt supported and appreciated.

There was a proactive ethos in the practice and every effort was made to put things right on the inspection day.

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

The practice was engaged with the local community offering short term work placement for disadvantaged individuals and offered emergency treatment for families visiting the local children’s hospice.

The practice had a positive approach to training and learning. We saw a selection of presentation training aids used to ensure staff remained up to date with current policies and practice procedures.

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.