Mitton Dental Surgery

We carried out this unannounced inspection on 5 December 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

Mitton Dental Surgery is in Stourport-on-Severn, Worcestershire and provides NHS and private dental care and treatment for adults and children.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for people with disabilities, are available near the practice.

The dental team includes three dentists, four dental nurses (two of whom are trainees), one dental hygienist and one receptionist. The practice has four treatment rooms.

The practice is owned by acompany and as a condition of registration must have a person registered with the CQC 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 Mitton Dental Surgery is the principal dentist.

On the day of inspection, we collected eight CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two dental nurses and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 7.45am to 6pm.

Tuesday from 7.45am to 6.45pm.

Wednesday from 8.30am to 5pm.

Thursday from 7.45am to 5pm.

Friday from 8.30am to 5pm.

Saturday from 8am to 12pm.

Our key findings were:

• The practice was undergoing extensive renovations and building works at the time of our inspection. The provider had taken ownership of two practices next door to one another in March 2019 and was structurally renovating them back into one building to enhance the facilities for patients.
• The provider had infection control procedures which mostly reflected published guidance. A dedicated decontamination room had been implemented within the last month as part of the renovation plan.
• Staff knew how to deal with emergencies. Most appropriate medicines and life-saving equipment were available. Those items that were identified by us as missing were obtained within 48 hours of the inspection.
• The provider had some systems to help them manage risk to patients and staff. Risk assessments for fire, legionella, sharps, general health and safety and new starters awaiting Hepatitis B immunity results had been scheduled post renovation work but not completed at the time of our visit. Radiation protection processes and protocols required review and updating.
• The provider had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures which reflected current legislation.
• 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 provided preventive care and supported patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and was implementing a culture of continuous improvement. At the time of our visit regular audit had not been completed due to the provider prioritising facility improvements and renovations.
• Staff felt involved and supported and worked 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 information governance arrangements.

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

• Improve the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular ensuring instruments are stored appropriately and reprocessed at identified intervals.
• Improve the practice's systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular ensuring risk assessments for legionella, fire, sharps, Hepatitis B immunity status and general health and safety are completed.
• Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Take action to ensure audits of radiography, record keeping, prescribing and infection prevention and control are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.