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Inspection Summary


Overall summary & rating

Updated 11 February 2016

We carried out an announced comprehensive inspection on 15 December 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Lion House dental practice provides general dental treatment to both NHS and private patients. It is located within the market town of Richmond, North Yorkshire. The practice currently has four dental practitioners, one of which is a foundation dentist and each has their own surgery. There is a waiting room, a reception area and a decontamination room.

The dentists are supported by a dental hygienist, a dental hygiene therapist and seven dental nurses.

The practice is open:

Monday to Thursday 09:00– 17:00

Friday 09:00 – 16:00

On the day of inspection we received 29 CQC comment cards providing feedback and spoke to two patients. The patients who provided feedback were very positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be caring, respectful and professional and they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

  • Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it.
  • There were sufficient numbers of suitably qualified staff to meet the needs of patients.
  • Staff had been trained to manage medical emergencies.
  • Infection control procedures were in accordance with the published guidelines.
  • Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current regulations.
  • Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
  • Patients were treated with dignity and respect and confidentiality was maintained.
  • The appointment system met patients’ needs.
  • There was a complaints system in place. Staff recorded complaints and cascaded learning to staff.
  • The practice sought feedback from staff and patients about the services they provided.

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

  • Review where the practice complaints policy is displayed so patients can access the information easily.
  • Review audits of various aspects of the service, such as radiography, infection prevention and control and dental care records, are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points so the resulting improvements can be demonstrated.
  • Review the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
  • Review the practice’s sharps risk assessments giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
Inspection areas

Safe

No action required

Updated 11 February 2016

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

The practice had effective systems and processes in place to ensure that all care and treatment was carried out safely. For example, there were systems in place for infection control, clinical waste control, dental radiography and management of medical emergencies. All emergency equipment and medicines were in date and in accordance with the British National Formulary (BNF) and Resuscitation Council UK guidelines.

We saw staff had received a variety of training in infection control. There was a decontamination room and guidance for staff on effective decontamination of dental instruments.

Staff had received training in safeguarding patients and knew how to recognise the signs of abuse and who to report them to including external agencies such as the local authority safeguarding team.

Staff were appropriately recruited, suitably trained and skilled to meet patients’ needs and there were sufficient numbers of staff available at all times; however references were not always sought for new members of staff. Staff induction processes were in place and had been completed by all staff. We reviewed the newest member of staff’s personal file and evidence was available to support the policy and process.

We reviewed the legionella risk assessment dated August 2012; evidence of regular water testing was being carried out in accordance with the assessment.

Effective

No action required

Updated 11 February 2016

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

Consultations were carried out in line with best practice guidance from the National Institute for Health and Care Excellence (NICE). For example, patients were recalled after an agreed interval for an oral health review, during which their medical histories and examinations were updated and recorded also any changes in risk factors were discussed and recorded.

The practice followed best practice guidelines when delivering dental care. These included guidance from the Faculty of General Dental Practice (FGDP) and NICE. The practice focused strongly on prevention and the dentists were aware of the ‘Delivering Better Oral Health’ toolkit (DBOH) with regards to fluoride application and oral hygiene advice.

Patients dental care records provided contemporaneous information about their current dental needs and past treatment. The dental care records we looked at included discussions about treatment options, relevant X-rays including grading and justification. The practice monitored any changes to the patients oral health and made referrals for specialist treatment or investigations where indicated in a timely manner.

Staff were registered with the General Dental Council (GDC) and maintained their registration by completing the required number of hours of continuing professional development (CPD). Staff were supported to meet the requirements of their professional registration.

Caring

No action required

Updated 11 February 2016

We found that this practice was providing caring services in accordance with

the relevant regulations.

Staff explained that enough time was allocated in order to ensure that the treatment and care was fully explained to patients in a way which patients understood.

Comments on the 29 completed CQC comment cards we received included statements saying they were involved in all aspects of their care and found the staff to be caring, respectful and professional and they were treated with dignity and respect in a clean and tidy environment. Patients we spoke with on the day confirmed this.

We observed patients being treated with respect and dignity during interactions at the reception desk and over the telephone.

Responsive

No action required

Updated 11 February 2016

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

Patients could access routine treatment and urgent care when required. The practice offered daily access for patients experiencing dental pain which enabled them to receive treatment quickly.

The practice had good disability access through the front door and the practice ensured the ramp was placed ready for a patient’s arrival.

The practice had a complaints process which was not easily accessible to patients who wished to make a complaint. Staff recorded complaints and cascaded learning to staff. They also had patients’ advice leaflets and practice information leaflets available on reception.

Well-led

No action required

Updated 11 February 2016

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

There was a clearly defined management structure in place. One of the dental nurses was responsible for the day to day running of the practice and also delegated tasks other members of staff.

Staff reported that the registered provider was approachable; they felt supported in their roles and were freely able to raise any issues or concerns with her at any time. The culture within the practice was seen by staff as open and transparent. Staff told us that they enjoyed working there.

The practice regularly undertook patient satisfaction surveys and was also undertaking the NHS Family and Friends Test; the latest results showed 94% of patients would recommend this service.

The practice held regular staff meetings which were minuted and gave everybody an opportunity to openly share information and discuss any concerns or issues which had not already been addressed during their daily interactions.

The practice undertook various audits to monitor their performance and help improve the services offered. The audits included infection control, patient dental care records and X-rays. The X-ray audit findings were not within the guidelines of the National Radiological Protection Board (NRPB).