All inspections: IDH Bexhill - Care Quality Commission

We carried out a comprehensive inspection of IDH Bexhill on 2 June 2015.

We inspected the practice previously on 18 August 2014 and asked the provider to make improvements regarding record keeping. We checked these areas as part of this comprehensive inspection and found this had been resolved.

IDH (Integrated Dental Holdings) is a national company which operates 600 dental practices across the United Kingdom. The practice provides general dentistry and domiciliary care. The Bexhill practice provides both NHS dental treatment and private dental treatment.

The practice is situated in the centre of Bexhill town. The practice has three dental treatment rooms, a decontamination room for the cleaning, sterilising and packing of dental instruments and a reception and waiting area. All services are provided on the ground floor. The main entrance to the practice is accessible by external steps. Therefore, access is difficult for patients with mobility difficulties.

The practice is open Monday to Thursday 8.30am – 5.00pm and 8.30am – 4.00pm on Fridays. The practice is closed between 1.00pm and 2.00pm.

IDH Bexhill has three dentists and three dental nurses (one of whom is a trainee). The practice manager and clinical team are supported by four receptionists. There was no hygienist in post at the time of inspection. The practice had additional support from a clinical support manager and a registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Before the inspection we sent CQC comments cards to the practice for patients to complete to tell us about their experience of the practice. We collected 13 completed cards. These provided a positive view of the service the practice provides. Patients commented that staff were professional, caring, friendly and polite. Patients wrote that they were listened to and staff made every effort to make suitable appointments. Patients also commented that they felt safe and observed the practice to be clean and hygienic. We also spoke with four patients during our inspection who were highly satisfied of the treatment and support they received at the practice.

We found that the practice was providing safe, effective, caring, responsive and well-led care in accordance with the relevant regulations.

Our key findings were:

There were comprehensive policies and procedures at the practice; however we found that some were out of date such as infection control and safeguarding children and vulnerable adults.
The practice had the equipment and medicines they would need in the event of a medical emergency and staff had appropriate training.
The practice took into account patient feedback, comments and complaints. However, there was no evidence to demonstrate that patient’s feedback and comments were used to improve the practice.
The practice was visibly clean and well maintained.
Patients were highly satisfied with the treatment they received and were complimentary about staff at the practice.
Staff received six monthly appraisals and felt well supported by their peers and managers.
The practice had a robust recruitment and induction process in place.

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

Provide a clear audit trail of the actions taken and any improvements made as a result of patient feedback and comments.
Ensure that all policies and protocols are up to date to reflect current guidelines, along with a robust policy review system. This includes the COSHH file.
Implement the appropriate segregation and removal of gypsum based on current waste guidelines.
Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.
Implement the recording of the justification and quality of any radiographs taken in all patient records.
Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
Ensure that all staff are aware of the requirements of the Mental Capacity Act 2005.

In September 2013 the provider was found non-compliant in three regulations. This was a follow up inspection to check the provider had taken the required actions to meet essential standards.

At our last inspection, we found the provider had not taken steps to ensure staff were supported to deliver treatment safely and to an appropriate standard. The provider had not ensured they were assessing and monitoring the service they provided. Records were not accurate and appropriately maintained. We found at this inspection the provider had taken some steps in meeting the essential standards but was still non-compliant in relation to records.

We reviewed staff records and found these contained evidence of relevant training undertaken and appraisals. Staff we spoke with told us that due to the new management structures they felt supported and had the right training to perform their roles effectively.

The practice manager was able to provide evidence of audits completed for patient's records, infection control, prescriptions and x-rays. Dental equipment was regularly serviced and maintained.

We found record keeping was not always up to date. We noted dates were missing from records which provided evidence that equipment had been checked. For example, daily checks for the sterilisation machine. This meant that although checks had been completed the provider could not evidence the day on which they were done.

We spoke with seven patients during our visit. Five patients had been visiting the practice for a number of years. They told us that their dentist, “Was terrific.” Five patients told us they were, “Happy with the service.” Two patients had recently started to use the practice and one patient told us they, “Had no concerns,” the other patient told us “The staff are very helpful.”

One patient told us they thought the practice was clean and they had seen staff wearing protective clothing in the surgery. We saw there were a number of policies and procedures in place for cleaning equipment in the practice.

We observed that staff were friendly, attentive and professional in their approach with the patients. We spoke with three staff, two managers and two dentists during our visit. Staff created a relaxed atmosphere and worked in a supportive way with each other. We found that staff were not adequately supported or trained to carry out their roles.

There was incomplete information about quality assurance processes in the practice. The provider could not evidence that patients were receiving a quality and safe service.

We found that record keeping was not up to date. There were assessments and audits that could not be located on the day of our visit.

Archived: IDH Bexhill

All Inspections

2 June 2015

During a routine inspection

18 August 2014

During an inspection looking at part of the service

13 August 2013

During a routine inspection