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Inspection Summary


Overall summary & rating

Updated 15 May 2019

We carried out this announced inspection on 11 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 CQC registration inspector and 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

Alexandra Dental Practice is based in Reading and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs via a portable ramp.

The dental team includes four dentists, five dental nurses, one trainee dental nurse, three dental hygienists, three receptionists and a practice manager. The practice has six treatment rooms of which five are in use.

The practice had recently been joined by a second practice following extensive renovation work to the first floor of the building. We did not inspect this second practice on the day of our inspection.

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 Alexandra Dental Practice is the practice manager.

On the day of our inspection we collected 19 CQC comment cards filled in by patients and obtained the views of five other patients.

During the inspection we spoke with two dentists, three dental nurses, one receptionist and the practice manager. Two support staff from head office were also in attendance at the inspection.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

  • Monday 7.00am to 5.00pm
  • Tuesday 7.00am to 5.00pm
  • Wednesday 8.00am to 5.00pm
  • Thursday 7.00am to 5.00pm
  • Friday 7.00pm to 2.00pm

Our key findings were:

  • The practice appeared clean and well maintained.
  • The practice had infection control decontamination procedures which reflected published guidance but improvements were needed.
  • Staff knew how to deal with medical emergencies
  • The practice had systems to help them manage risk but did not operate these effectively.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children but training required improvement.
  • Improvements were needed to staff recruitment procedures.
  • The practice did not ask for patient feedback about the services they provided.
  • The practice was providing preventive care and supporting patients to ensure better oral health.
  • The appointment system met patients’ needs.
  • The management of staff training was not effective.
  • Staff felt involved, supported and worked well as a team.
  • The management of significant event and complaints was not effective.
  • The practice had suitable information governance arrangements.
  • The practice did not have effective clinical and management leadership or a culture of continuous improvement.
  • We have been provided evidence to confirm all but one of the shortfalls identified have been addressed. The area outstanding is effective staff recruitment processes.

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

  • Review the practice's recruitment procedures to ensure appropriate checks are completed prior to new staff commencing employment at the practice.

Inspection areas

Safe

No action required

Updated 15 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.

All but four staff received training in safeguarding and knew how to recognise the signs of abuse and how to report concerns. We have since received evidence to confirm this shortfall is being addressed.

Improvements were needed to ensure fire safety management at the practice was effective. We have since received evidence to confirm this shortfall is being addressed.

Improvements were needed to the management of re-sheathing needles. We have since received evidence to confirm this shortfall has been addressed.

Staff were qualified for their roles and the practice completed essential recruitment checks but improvements were needed to ensure references and DBS checks were carried out.

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

Medicines management required improvement to ensure out of hours dispensing followed regulations. We have since received evidence to confirm this shortfall has been addressed.

Improvements were needed to the management of clinical waste, frequency of infection control audits and staff Hepatitis B immunity. We have since received evidence to confirm theses shortfall have been addressed.

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

Effective

No action required

Updated 15 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 thorough and clearly explained.

The dentists discussed treatment with patients so they could give informed consent. We noted informed consent was not routinely recorded in patient records. We have since received evidence to confirm this shortfall is being addressed.

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 but improvements were needed to manage this effectively. We have since received evidence to confirm this shortfall is being addressed.

Caring

No action required

Updated 15 May 2019

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

We received feedback about the practice from 24 people. Patients were positive about all aspects of the service the practice provided. They told us staff were gentle and caring.

They said that they were given a professional advice 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.

The windows in one treatment room were overlooked by the path and car park. We asked the practice to consider remedial action to protect patients’ privacy. We have since received evidence to confirm this shortfall has been addressed.

Responsive

No action required

Updated 15 May 2019

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 telephone interpreter services and had arrangements to help patients with sight loss. The practice did not have arrangements in place to support patients who experienced hearing loss. We have since received evidence to confirm this shortfall has been addressed.

The practice took patients views seriously. They valued compliments from patients and responded to concerns and complaints quickly and constructively. Complaints were not logged effectively which meant it was difficult to ascertain what action had been taken. We have since received evidence to confirm this shortfall has been addressed.

Well-led

No action required

Updated 15 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.

A number of risk assessments had been carried out in February 2019 which prompted action plans. We reviewed a health and safety, fire, access and legionella risk assessments and found all had actions outstanding. We have since received evidence to confirm this shortfall is being addressed.

The practice team kept patient dental care records which were, clearly typed and stored securely. Improvements were needed to ensure patient consent was recorded in records. We have since received evidence to confirm this shortfall has been addressed.

Improvements were needed to ensure that antimicrobial, patient care records and radiograph audits were carried out effectively. We have since received evidence to confirm this shortfall is being addressed.