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Inspection Summary


Overall summary & rating

Updated 22 February 2018

We carried out this announced inspection on 9 January 2018 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; an interpreter was also present during this inspection.

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

Medical-Dent is located in West Bromwich, West Midlands and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. The practice does not have a car park but a local pay and display car park is available near the practice.

The dental team includes six dentists, (one of which has a special interest in orthodontics and one implantologist), two qualified dental nurses, two newly employed trainee dental nurses and two dental support workers. One of these dental nurses mainly works on reception but will work as a dental nurse if required. The practice has two ground floor treatment rooms.

The practice is owned by a company 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 Medical-Dent was the practice owner.

On the day of inspection we collected 24 CQC comment cards filled in by patients and spoke with five other patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, two dental nurses one of whom was working at reception 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 10am to 9pm, Saturday 9am to 9pm and Sunday 11am to 9pm.

Our key findings were:

  • The practice was clean and well maintained.
  • The practice had infection control procedures which reflected published guidance.
  • Staff knew how to deal with emergencies. Not all of the required life-saving equipment was available but this was purchased shortly after this inspection.
  • The practice had systems to help them manage risk.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The practice had thorough staff recruitment procedures.
  • The clinical staff provided patients’ care and treatment in line with current guidelines. Not all of the dentists were recording basic periodontal scores or grading or justifying the need to take X-rays in patient dental care records.
  • Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
  • The appointment system met patients’ needs.
  • The practice had effective leadership. Staff felt involved and supported and worked well as a team.
  • The practice asked staff and patients for feedback about the services they provided.
  • The practice dealt with complaints positively and efficiently.

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

  • Review the practice’s sharps procedures and 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 protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

  • Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users

  • Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a GDC registered and appropriately trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
Inspection areas

Safe

No action required

Updated 22 February 2018

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 to help them improve. Not all complaints were recorded as an incident and discussed with staff. The registered manager confirmed that changes would be made to ensure systems enabled staff to learn from all complaints made. Two never events were recorded on the complaint log; there was no evidence of any discussions held or learning from these events.

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

Some staff were qualified for their roles and the practice completed essential recruitment checks. Dental support workers employed were not registered with the GDC and were not registered on an appropriate training course in order to gain registration. Following this inspection we received confirmation that these staff members were registered on an on-line dental nurse training course.

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

The practice had suitable arrangements for dealing with medical and other emergencies.

Effective

No action required

Updated 22 February 2018

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. Improvements were required to record keeping. Patients described the treatment they received as professional, efficient and caring. 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 supported staff to complete training relevant to their roles and had systems to help them monitor this.

Caring

No action required

Updated 22 February 2018

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

We received feedback about the practice from 29 people. Patients were positive about all aspects of the service the practice provided. They told us staff were kind, caring and friendly. They said that they were given clear 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 22 February 2018

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

The practice’s appointment system was efficient and met patients’ needs. Patients could get an appointment quickly if in pain.

Staff considered patients’ different needs. This included providing facilities for disabled patients and families with children. The practice had access to interpreter services and had arrangements to help patients with sight or hearing loss. The patient toilet was on the ground floor of the building but there was no emergency pull cord and the toilet had not been adapted for use by disabled patients.

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 22 February 2018

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 practice 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.