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Inspection Summary


Overall summary & rating

Updated 14 November 2017

We carried out this announced inspection on 4 October 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They provided information which we took into account.

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

Let's Smile Limited also known as Stanstead Abbotts Dental Care is in Stanstead Abbotts, and provides NHS and private treatment to patients of all ages.

There is a portable ramp for access for people who use wheelchairs or pushchairs. Car parking spaces are available on the street and in a public car park near the practice.

The dental team includes three dentists, four dental nurses/receptionists, one dental hygienist and two practice managers. The practice is situated on the ground floor and has three treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 44 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

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

The practice is open: Monday, Tuesday and Thursday from 8am to 1pm and from 2pm to 6pm. Wednesday from 8am to 1pm and from 2pm to 7pm and Friday from 8am to 1pm and from 2pm to 5pm. The practice offers occasional Saturday morning services from 8am to 12am by appointment.

Our key findings were:

  • The practice was visibly clean. There were no cleaning schedules in place and no review of housekeeping and maintenance tasks.
  • The practice had infection control procedures; improvements were required to ensure staff followed the processes and published guidance.
  • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
  • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
  • The practice did not have formalised staff recruitment procedures.
  • 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.
  • 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 system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
  • Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
  • Review the practices’ current Legionella risk assessment and implement the required actions taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance,’ including the regular monitoring of water temperatures.
  • Review practice's recruitment procedures to ensure that appropriate background checks are completed prior to new staff commencing employment at the practice. .
  • Review the practice’s protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
  • Review the staff supervision protocols and ensure an effective process is established for the on-going appraisal of all staff.
Inspection areas

Safe

No action required

Updated 14 November 2017

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.

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

Staff were qualified for their roles. There was scope to improve the practice process for completing and recording essential recruitment checks.

Premises and equipment were clean and properly maintained. Improvements were required to ensure 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 14 November 2017

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 respectful and professional. 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 14 November 2017

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

We received feedback about the practice from 46 people. Patients were positive about all aspects of the service the practice provided. They told us staff were kind and professional. They said that they were given helpful, honest 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 14 November 2017

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. There was no hearing loop at the practice. Staff said they had access to interpreter/translation services and we were told the clinicians were able to translate a number of languages.

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 14 November 2017

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

The practice had some policies, procedures and risk assessments to support the management of the service and to protect patients and staff. Some of the risk assessments were not effective, had not complied with, identified or considered risks. For example, recommendations identified from the legionella risk assessment had not been actioned, there was a lack of awareness of the potential risk that dental equipment may not have been effectively cleaned from the overloading of the ultra-sonic bath and the potential for injuries to staff and patients from broken office furniture and furnishings had not been mitigated.

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. Staff felt supported and appreciated by the principal dentist.