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Inspection Summary


Overall summary & rating

Updated 7 July 2017

We carried out this announced inspection on 31 May 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information for us to take into account.

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

The Lawns Dental Practice is located in Long Sutton, near Spalding and provides private treatment to patients of all ages and NHS treatment to children.

There is level access for people who use wheelchairs and pushchairs. There are some limited car parking spaces, including one for patients with disabled badges, directly outside the practice. There is also free on street parking close to the practice.

The dental team includes three dentists, three dental nurses, one trainee dental nurse, two dental hygienists and one receptionist. The practice has three treatment rooms, all on the ground level.

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 The Lawns Dental Practice was the principal dentist.

The principal dentist took ownership of the practice in April 2017. The principal dentist had joined the practice in September 2016. One of the dentists who previously owned the practice, is seeking retirement within the next twelve months.

On the day of inspection we collected 47 CQC comment cards filled in by patients. This information gave us a positive view of the practice. We did not receive any negative comments about the practice.

During the inspection we spoke with two dentists, one dental nurse, the trainee nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Friday from 9am to 5pm. The practice is closed between 1pm to 2pm during these days.

Our key findings were:

  • The practice ethos included the provision of dental services in a safe and ethical environment.
  • Effective leadership was evident although we found areas where management arrangements could be strengthened.
  • Staff had been trained to deal with emergencies. We found appropriate medicines were readily available in accordance with current guidelines. We found there were some items of equipment missing.
  • The practice appeared clean and well maintained.
  • Staff demonstrated awareness in relation to their responsibilities for safeguarding adults and children living in vulnerable circumstances. We found that a number of staff required training to an appropriate level to manage safeguarding concerns however.
  • Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
  • The practice demonstrated awareness of the needs of some of the local population and took these into account when delivering the service. We noted further measures were required to ensure that all of the needs of the local population were taken into account.
  • Patients had access to treatment and urgent and emergency care when required.
  • Staff received most training appropriate to their roles, although we noted refresher training was required in the Mental Capacity Act 2005 and Gillick competence. Staff were supported in their continued professional development (CPD) by the practice.
  • Staff we spoke with felt supported by the provider and were committed to providing a quality service to their patients.
  • The practice asked patients for feedback about the services they provided. Information we obtained from 47 Care Quality Commission cards provided positive feedback. We did not receive any negative feedback about the practice.

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

  • Review their governance arrangements to effectively support the management of the service. This should include improvements in training, policy, procedures and risk management.

  • Regularly monitor and record water temperatures as part of the Legionella risk assessment taking into account guidelines issued by the Department of Health - Health Technical Memorandum01-05: Decontamination in primary care dental practices.

  • Review the storage arrangements for paper records held on site to ensure they are held securely.

Inspection areas

Safe

No action required

Updated 7 July 2017

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 but we found areas that required strengthening. The practice had not recorded any significant events.

We found that whilst some staff had received training in safeguarding, not all staff had been trained to an appropriate level and some staff required refresher training. Staff we spoke with showed awareness of safeguarding issues.

Staff were qualified for their roles and the practice completed most essential recruitment checks. We noted an exception in relation to the provider obtaining staff identity verification at the point of recruitment.

Premises and equipment were clean and properly maintained. The practice followed national guidance for cleaning, sterilising and storing dental instruments. We noted that infection prevention control audits had been undertaken annually however, guidance recommended these audits to be undertaken twice yearly.

The practice had most suitable arrangements for dealing with medical and other emergencies. We noted that some equipment was missing and this was required to ensure that all medical emergencies could be responded to effectively. We were informed that this had been ordered after our inspection took place.

Effective

No action required

Updated 7 July 2017

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

The dentists assessed patients’ needs and provided care and treatment in line with recognised guidance. Patients described the treatment they received as excellent, professional and first class. The dentists 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.

We noted that staff refresher training was required in the Mental Capacity Act 2005 and Gillick competence to ensure detailed knowledge and understanding of the principles involved.

Caring

No action required

Updated 7 July 2017

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

the relevant regulations.

We received feedback about the practice from 47 people who completed CQC comment cards. Patients were positive about all aspects of the service the practice provided. They told us staff were professional, caring and took their time to ensure patients felt comfortable during procedures.

Patients said that they were given detailed and helpful explanations about dental treatment, and said their dentist listened to them. Patients commented that the dental team 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 7 July 2017

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 some facilities for disabled patients and families with children. The practice had access to interpreter services. The practice had not installed a call bell in the patient toilet or hearing loop at the reception desk. They told us they would consider any arrangements which would assist patients with particular needs.

The practice told us they considered patients views seriously. They told us they valued compliments from patients and information we reviewed showed the practice responded to verbal complaints quickly and constructively.

Well-led

No action required

Updated 7 July 2017

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. However, we noted there were also areas of improvement required in governance arrangements. These included ensuring that all risks were identified, addressed promptly and appropriate action taken to manage and reduce risks from occurring.

There was a clearly defined management structure and staff felt supported and appreciated.

The practice team kept complete patient dental care records which were, cleary written or 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.