Background to this inspection
Updated
4 January 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
We carried out an announced, comprehensive inspection on 22 November 2016. The inspection team consisted of a Care Quality Commission (CQC) inspector and a dental specialist advisor.
Before the inspection we asked for information to be sent, this included the complaints the practice had received in the last 12 months; their latest statement of purpose; the details of the staff members, their qualifications and proof of registration with their professional bodies.
We reviewed policies, procedures and other documents. We received feedback from 16 patients about the dental service.
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 therefore formed the framework for the areas we looked at during the inspection.
Updated
4 January 2017
We carried out an announced comprehensive inspection on 22 November 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
The practice is located in a semi-detached property close to Mansfield town centre. The practice is located on two floors of premises with patient areas on both the first and ground floor. The practice provides mostly NHS dental treatments (95%). There is time limited car parking to the front of the practice or pay and display car parking in the town centre. There are four treatment rooms two of which are located on the ground floor.
The practice provides regulated dental services to both adults and children. Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment.
The practice’s opening hours are – Monday to Wednesday: 8:30 am to 6 pm; Thursday: 8:30 am to 5 pm; Friday: 8:30 am to 4 pm. The practice is closed at the weekend.
Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message. Alternatively patients could telephone the NHS 111 telephone number.
The practice manager is the registered manager. 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.
The practice is registered with the Care Quality Commission (CQC) as an organisation.
The practice has four dentists (one is a locum dentist); one dental hygienist/ therapist; one qualified dental nurse; two trainee nurses; one receptionist and one practice manager.
Before the inspection we sent CQC comments cards to the practice for patients to tell us about their experience of the practice. We also spoke with patients during the inspection to gather their views of the practice. We received feedback from 16 patients who provided a positive view of the services the practice provides.
Our key findings were:
- The premises were visibly clean and there were systems and processes in place to maintain the cleanliness.
- Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
- Six monthly infection control audits had not been completed as recommended in the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05)
- Patients said they had no problem getting an appointment that suited their needs.
- Patients were able to access emergency treatment when they were in pain.
- Patients provided positive feedback about their experiences at the practice. Patients said they were treated with dignity and respect; and the dentist involved them in discussions about treatment options and answered questions.
- Patients’ confidentiality was protected.
- There were systems to record accidents, significant events and complaints, and where learning points were identified these were shared with staff.
- The records showed that apologies had been given for any concerns or upset that patients had experienced at the practice.
- With the exception of regular audits the practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
- There was a whistleblowing policy accessible to all staff, who were aware of procedures to follow if they had any concerns.
- The practice had the necessary equipment for staff to deal with medical emergencies, and staff had been trained how to use that equipment. This included an automated external defibrillator, oxygen and emergency medicines.
There were areas where the provider could make improvements and should:
- Review the practice’s infection control procedures and protocols in relation to carrying out six monthly audits as identified in the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.