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Inspection Summary


Overall summary & rating

Updated 23 May 2019

We carried out this announced inspection on 1 May 2019 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

The Smiles Studio is in Chandlers Ford and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes eight dentists, one oral surgeon, one lead dental nurse, five dental nurses, three trainee dental nurses, one dental hygienist, one practice manager, one business manager and three receptionists. The practice has four treatment rooms.

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 Smiles Studio is the principal dentist. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection, we collected 40 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with four dentists, one lead dental nurse, one dental nurse, three trainee dental nurses, two receptionists, one business manager 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 to Friday 8.30am to 5pm

Saturday 8.30am to 1pm

Our key findings were:

  • The practice appeared clean and well maintained, however improvements could be made to the cleaning file with additional documentation.
  • The provider had infection control procedures which reflected published guidance, improvements could be made to workflows and conditions in the decontamination room.
  • Staff knew how to deal with emergencies. Appropriate medicines and most life-saving equipment were available, however some face masks were not available as recommended in guidance.
  • Improvements could be made by ensuring that staff fully understood ‘safer sharps’ and implemented guidance.
  • Improvements could be made by carrying out an antimicrobial prescribing audit, which would confirm guidelines were being followed and antibiotic stewardship understood by staff.
  • Improvements should be made to ensure that all actions from the legionella risk assessment had been completed.
  • The practice had systems to help them manage risk to patients and staff.
  • Improvements could be made by reviewing the use of rubber dams and ensuring staff use was in line with guidelines.
  • The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
  • The provider 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, however improvements could be made by ensuring that treatment room view ports provided sufficient privacy to patients.
  • Staff were providing preventive care and supporting patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider had effective leadership and culture of continuous improvement. however improvements could be made to the auditing processes with independent verification.
  • Improvements could be made to Control of Substances Hazardous to Health (COSHH) Regulations 2002 file to ensure the safe storage and use of materials used.
  • Staff felt involved and supported and worked well as a team.
  • The provider asked staff and patients for feedback about the services they provided.
  • The provider dealt with complaints positively and efficiently.
  • The provider had suitable information governance arrangements, however improvements could be made to CCTV signage.

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

  • Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.

  • Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

  • Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
  • Review the practice's Legionella risk assessment and implement any recommended actions, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’
Inspection areas

Safe

No action required

Updated 23 May 2019

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.

Improvements could be made to Control of Substances Hazardous to Health (COSHH) Regulations 2002 file to ensure the safe storage and use of materials used.

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

Improvements should be made to ensure that all actions from the legionella risk assessment had been completed.

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

Premises and equipment were clean and properly maintained. Improvements could be made to the cleaning file with additional documentation.

Improvements could be made by reducing, or removing, the permanent use of temporary extension cables throughout the practice.

Improvements could be made by reviewing the use of rubber dams and ensuring staff use was in line with guidelines.

Improvements could be made by ensuring that staff fully understood ‘safer sharps’ and implemented guidance.

Improvements could be made to the cone beam computed tomography machine by implementing a quality assurance process in line with guidelines.

The practice followed national guidance for cleaning, sterilising and storing dental instruments, however improvements could be made to workflows and conditions in the decontamination room.

The practice had suitable arrangements for dealing with medical and other emergencies, however some items such as face masks and airways were not available as recommended in guidance.

Improvements could be made by carrying out an antimicrobial prescribing audit, which would confirm guidelines were being followed and antibiotic stewardship understood by staff.

Effective

No action required

Updated 23 May 2019

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 always a great service, excellent and professional. 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.

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

The staff were involved in quality improvement initiatives such as good practice as part of its approach in providing high quality care.

Caring

No action required

Updated 23 May 2019

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

We received feedback about the practice from 42 people. Patients were positive about all aspects of the service the practice provided. They told us staff were good, helpful and informative.

They said that they were given professional, helpful and accurate 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, however improvements could be made by ensuring that treatment room view ports provided sufficient privacy to patients. Patients said staff treated them with dignity and respect.

The practice had suitable information governance arrangements, however improvements could be made to CCTV signage.

Responsive

No action required

Updated 23 May 2019

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 get an appointment quickly if in pain.

Staff considered patients’ different needs. This included providing facilities for patients with a disability and families with children. The practice had access to telephone 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 23 May 2019

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.

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

The provider monitored clinical and non-clinical areas of their work to help them improve and learn, however improvements could be made to the auditing processes with independent verification. This included asking for and listening to the views of patients and staff.