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Reports


Inspection carried out on 12 November 2019

During a routine inspection

We carried out this announced inspection on 12 November 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 not providing well-led care in accordance with the relevant regulations.

Background

Leven Vale Dental Practice is in Yarm and provides NHS and private dental treatment to adults and children.

The practice is in a purpose-built ground floor premises. There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes a principal dentist, four associate dentists, a visiting dentist, seven dental nurses, a dental hygiene therapist and a receptionist. A practice manager has recently been appointed to support the dental team. The practice has four treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 38 CQC comment cards filled in by patients. These provided a positive view of the dental team and care provided by the practice.

During the inspection we spoke with three dentists, three dental nurses, the receptionist 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 Thursday 9am to 5pm

Friday 9am to 4pm.

Our key findings were:

  • The practice appeared clean and well maintained.
  • The provider had infection control procedures which reflected published guidance; improvements could be made to the practice’s manual scrubbing procedures for dental instruments.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available apart from a child sized resuscitation bag. This was ordered on the inspection day. Medical emergency drugs and equipment were not easily accessible to staff.
  • The provider had systems to help them manage risk to patients and staff. Risk management systems could be improved in recording of prescriptions and checking of staff’ immunity to Hepatitis B.
  • The provider did not have suitable protocols in place for the safeguarding of vulnerable adults and children. Staff had not received training to the appropriate level and were not confident of 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.
  • Staff provided preventive care and supported patients to ensure better oral health.
  • The appointment system took account of patients’ needs.
  • The provider should review the leadership, governance and management of the dental practice to promote a culture of continuous improvement.
  • 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.
  • The practice has been a training practice for newly qualified dentists since 2014.

We identified regulations the provider was not complying with. They must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting is at the end of this report.

Inspection carried out on 15 September 2016

During a routine inspection

We carried out an announced comprehensive inspection on 15 September 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

Leven Vale Dental Practice is situated on the outskirts of Yarm, a small market town in Cleveland. The practice occupies a purpose-built ground floor premises and provides predominantly NHS treatment to patients of all ages. There are three treatment rooms, an open-plan reception and waiting area, a dedicated decontamination room for sterilising dental instruments, two changing /storage rooms, a staff kitchen and a general office. Car parking is available within the practice grounds. Access for wheelchair users or pushchairs is possible via the ramp outside and within the entire building.

The practice is open Monday to Thursday 0900-1700 and Friday 0900-1600.

The dental team is comprised of the principal dentist, an associate dentist, a foundation dentist, three qualified dental nurses (one being the administration lead), a trainee dental nurse and a receptionist.

The practice provides general dentistry and is actively involved in vocational foundation training for newly qualified dentists (foundation training enables newly qualified dentists to work within the National Health Service (NHS) system). The practice is passionate about oral health promotion and was involved in community programmes (fluoride varnish application and oral health education) within schools over the last two years. A programme is currently under review for next year.

The principal dentist is the registered provider. A registered provider has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We reviewed 41 Care Quality Commission (CQC) comment cards on the day of our visit; patients were very positive about the staff and standard of care provided by the practice. Patients commented they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.

Our key findings were:

  • All staff were welcoming and friendly.
  • The practice was well organised and the premises was visibly clean and free from clutter.
  • An infection prevention and control policy was in place and sterilisation procedures followed recommended guidance.
  • The practice had systems for recording incidents and accidents.
  • Practice meetings were used for shared learning.
  • The practice had a safeguarding policy and staff were aware on how to escalate safeguarding issues for children and adults should the need arise.
  • Staff received annual medical emergency training.
  • The practice was actively involved in promoting oral health.
  • Dental professionals provided treatment in accordance with current professional guidelines.
  • Patients could access urgent care when required.
  • Dental professionals were maintaining their continued professional development (CPD) in accordance with their professional registration.
  • Patient feedback was regularly sought and reflected upon.
  • Complaints were dealt with in an efficient and positive manner.

There were areas where the provider could make improvements and should:

  • Review the practice’s recruitment policy and procedures to ensure that all staff undergo Disclosure and Barring Service (DBS) checks prior to employment.
  • Review the practice’s legionella risk assessment. Implement the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
  • Review the practice’s procedures for undertaking six-monthly infection prevention and control audits as recommended by the Department of Health: Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices.
  • Review the practice’s procedures for undertaking staff satisfaction surveys to help improve the quality of service.
  • Review the practice responsibilities with regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 to ensure all documentation is up to date and staff understand how to minimise risks associated with the use and handling of these substances.

Inspection carried out on 29 January 2014

During a routine inspection

We spoke to people who used the service, who told us they were happy with the service, and that their treatments and any fees were explained thoroughly to them before treatment commenced. Comments from people included �The service has been very good� �It�s been absolutely fine, no concerns at all� and "It's always nice and clean and friendly". People were also asked for their views on the service.

All the people we spoke to were very satisfied that they had received appropriate care, treatment and support, with comments including " I've never had a problem with anything here". Medical history and patient details were sought before treatment commenced. There were appropriate arrangements in place to deal with any emergencies.

The practice had appropriate policies and procedures in place for infection control and the decontamination of dental instruments. We observed staff following these procedures correctly. This ensured that people were cared for in a clean, hygienic environment.

Staff were appropriately skilled and trained for their work, and said they felt well supported within the workplace. The provider carried out appropriate auditing of the practice and sought patient feedback to ensure a good service was provided.