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Inspection Summary


Overall summary & rating

Updated 8 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 Care Quality Commission (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

Old Street Dental Clinic is in London and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes eight dentists, two qualified dental nurses, a trainee dental nurse, two dental hygienists and a receptionist. 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 the inspection, we collected 30 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, two dental nurses, a dental hygienist, and the receptionist. We checked practice policies and procedures and other records about how the service is managed.

The practice is open at the following times:

Monday to Thursday 8am-7pm

Friday 8am-6pm

Saturday 8.30am-2pm

Our key findings were:

  • The practice appeared clean and well maintained.
  • The provider had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • 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 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 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 provider had staff recruitment procedures that required improvement to be in line with current national guidance and legislation. The provider revised some of these immediately after the inspection.
  • The provider had systems to manage incidents, but an incident had not been suitably documented.
  • All staff had been immunised against Hepatitis B, but the provider had not sought assurances that two members of clinical staff had achieved suitable immunity.
  • The provider had audited clinical and non-clinical processes. Improvements were required to have in place an effective system for carrying out regular audits of dental radiography for all relevant dental clinicians.

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

  • Review practice's recruitment procedures to ensure that appropriate background checks are completed prior to new staff commencing employment at the practice.
  • Review the practice’s system for the documentation of actions taken, and learning shared, in response to incidents with a view to preventing further occurrences and ensuring that improvements are made as a result.
  • Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
  • Review the practice’s systems for carrying out clinical audits, such as for dental radiography, and reviews to identify, share, and where applicable act on areas for improvement.
Inspection areas

Safe

No action required

Updated 8 May 2019

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

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

The premises and equipment were clean and properly maintained. The provider followed national guidance for cleaning, sterilising and storing dental instruments.

The provider had arrangements for dealing with medical and other emergencies.

Staff were qualified for their roles and the provider completed essential recruitment checks. The provider completed further checks for staff immediately after the inspection to ensure their processes were in line with current legislation requirements.

The provider had systems and processes to provide safe care and treatment. They used learning from incidents and complaints to help them improve. An incident had not been suitably documented.

All staff had been immunised against Hepatitis B. The provider had not sought assurances that two members of clinical staff had achieved suitable immunity.

Effective

No action required

Updated 8 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 excellent, professional and caring.

The dentists discussed treatment with patients so they could give informed consent and recorded this in their records.

The practice had arrangements for patient requiring referral 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.

Caring

No action required

Updated 8 May 2019

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

We received feedback about the practice from 30 people. Patients were positive about all aspects of the service the practice provided. They told us staff were friendly and professional and put them at ease.

They said that they were given clear information about their dental care and said their dental clinician listened to them.

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 8 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 they were experiencing dental pain.

Staff considered patients’ different needs. This included providing facilities for patients with a disability and people with children.

The provider told us they took patients’ views seriously. They said they valued compliments from patients and responded to concerns and complaints quickly and constructively.

Well-led

No action required

Updated 8 May 2019

We found that this practice was providing well-led care in accordance with the relevant regulations.

The provider 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 typed and stored securely.

The provider 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.

The provider had carried out clinical audits of radiography but could strengthen arrangements by ensuring these audits were completed at regular intervals, and to include all relevant dental clinicians.