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Inspection Summary


Overall summary & rating

Updated 20 May 2019

We carried out this announced inspection on 15 April 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

518 Dental is in Rochdale and provides NHS treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice on local side streets.

The dental team includes four dentists (two of whom are principals) and seven dental nurses (two of whom dual role as the practice manager and receptionist), the remaining five dental nurses are trainees. 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 518 Dental is one of the principal dentists.

On the day of inspection, we collected 34 CQC comment cards filled in by patients. All comments reflected positively on the service.

During the inspection we spoke with four dentists and four dental nurses. 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 5:30pm and Friday 8am to 3pm.

Our key findings were:

  • The practice appeared clean and well maintained.
  • The provider had infection control procedures. Improvements could be made to the process to ensure they fully reflect published guidance.
  • Staff knew how to deal with emergencies. Improvements could be made to ensure all appropriate medicines and life-saving equipment was available in line with guidance.
  • The practice had systems to help them manage risk to patients and staff.
  • 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.
  • 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 a culture of continuous improvement. Improvements could be made to ensure audits were completed effectively and learning outcomes were documented.
  • 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.

During the inspection we identified an area of notable practice in respect to their responsiveness to the needs of different people including those in vulnerable circumstances. We saw evidence of team involvement in practice and within the wider community. The practice was involved in the following in-house and external initiatives with the aim of promoting oral health and helping to improve care. In particular: Healthy Living dentistry and Baby Teeth Do Matter which are part of the Greater Manchester Combined Authority initiative, Rochdale connecting You, Homeless Alliance Response Team (HART) and links to Dental Public Health.

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

  • Review the practice’s infection control procedures and protocols 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’. In particular: Use of personal protective equipment (PPE), instrument cleaning and water temperature monitoring.
  • Review the availability of equipment and medicines in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council and the British National Formulary.
  • Review the practice’s protocols to ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

Inspection areas

Safe

No action required

Updated 20 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.

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

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

Premises and equipment were clean and properly maintained. We found the practice followed national guidance for sterilising and storing dental instruments, but improvements could be made to the cleaning process and use of personal protective equipment.

The practice had suitable arrangements for dealing with medical and other emergencies. The process to manage medical emergency equipment and medicines in line with guidance could be improved.

Effective

No action required

Updated 20 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 delivered with a kind and considerate approach and always treated with dignity and respect. 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 practice offered a fluoride clinic three times a week for children aged 3 to16 years. This service was delivered by a dental nurse who had undertaken additional training.

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

Caring

No action required

Updated 20 May 2019

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

We received feedback about the practice from 34 people. Patients were positive about all aspects of the service the practice provided. They told us staff were very knowledgeable, professional and kind.

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 20 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 interpreter services and had arrangements to help patients with dexterity impairment, sight or hearing loss.

The team were able to communicate in several different languages, including, Urdu, Punjabi, Russian and Lithuanian.

The practice was involved in local community initiatives such as the ‘Homeless Alliance Response Team’ (HART) and ‘Rochdale Connecting You’.

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 20 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, this included asking for and listening to the views of patients and staff. Improvements could be made to ensure audits have documented learning points and the resulting improvements can be demonstrated