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Inspection Summary


Overall summary & rating

Updated 6 April 2016

We carried out an announced comprehensive inspection on 1 March 2016 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

The practice is situated on the outskirts of Chester city centre and has a waiting/reception room, four treatment areas, a decontamination room, administrative offices and an annexe building housing a further treatment room and patient consultation and waiting areas. The practice has three dentists, three dental therapists, six qualified dental nurses, receptionists, administrator and a practice manager. The practice is a specialist dental surgery providing orthodontic treatment to both adults and children. Orthodontics is specialist dental treatment that corrects irregularities of alignment of the teeth in order to improve position, appearance and function of crooked or abnormally arranged teeth. They provide these services predominately to NHS patients and also to some private patients. The practice receives dental referrals from dental practices all over the North West, Cheshire, Shropshire, The Wirral and North Wales.

The practice is open:

Monday, Tuesday, Thursday and Friday 9am – 1pm and 2pm – 5pm and Wednesday 9am – 1pm 2pm – 6pm.

The principal dentist is the 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.

We received feedback from 35 patients about the service. The 31 CQC comment cards seen and four patients spoken to reflected very positive comments about the staff and the services provided. Patients commented that the practice appeared clean and tidy and they found the staff very caring, friendly and professional. They had trust and confidence in the dental treatments and said explanations from staff were clear and understandable. They told us appointments usually ran on time and they would highly recommend the practice.

Our key findings were:

  • The practice reported and recorded accidents and complaints. They did not have a significant event analysis policy and procedures in place; however were to implement a system soon.
  • Staff had received safeguarding training and knew the processes to follow to raise any concerns.
  • There were sufficient numbers of suitably qualified staff to meet the needs of patients.
  • Staff had been trained to deal with medical emergencies and emergency medicines and emergency equipment were available.
  • Infection prevention and control procedures were in place.
  • Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation within their specialist field.
  • 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 their confidentiality was maintained.
  • The appointment system met the needs of patients and waiting times were kept to a minimum.
  • The practice staff felt valued, involved and worked as a team.
  • The practice took into account any comments, concerns or complaints and used these to help them improve.

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

  • Review the storage of dental care records to ensure they are stored safely and meet health and safety and fire regulations in accordance with the Department of Health’s code of practice for records management (NHS Code of Practice 2006) and other relevant guidance about information security and governance.
  • Review the practice’s system for the 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 storage of clinical waste to ensure it was safe and secure.
  • Review the access to the local decontamination unit (LDU).
  • Review fire safety training to ensure staff undertake this annually and fire safety drills six monthly.
  • Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal references taken and ensuring recruitment checks, including references, are obtained and recorded.
  • Review the availability of an interpreter service for patients who do not speak English as their first language.

We also found areas of notable practice:

  • Dentists, therapists and dental nurses all had specialist skills supported by enhanced skills training. They worked well as a team supporting each other and were able to undertake extended roles such as in radiography and impression taking.
  • All patients had their treatment peer assessed and rated using the orthodontic peer assessment rating (PAR) index. Staff were all trained and calibrated in PAR. (The PAR index is a robust way of assessing the standard of orthodontic treatment that an individual provider is achieving and determining the outcome of the orthodontic treatment in terms of improvement and standards). In orthodontics it is important to objectively assess whether a worthwhile improvement has been achieved in terms of overall alignment and occlusion for an individual patient or the greater proportion of a practitioner's caseload. This practice quality assured all their patients treatment using the PAR index.
Inspection areas

Safe

No action required

Updated 6 April 2016

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

The practice had systems and processes in place to ensure care and treatment was carried out safely. The practice reported and documented accidents and complaints. There was no system in place to report, analyse and learn lessons from significant events. On discussion the practice told us they would implement a system following best practice.

Safety alerts were received by the practice and disseminated to relevant staff for action. There was evidence of action taken in response to safety alerts.

Infection prevention and control procedures were in place and staff had received training in infection control. The local decontamination unit (LDU) was accessible and not locked. Clinical waste was stored where it was potentially accessible to patients and public.

The dental X-ray unit was suitably sited and used by trained staff. Local rules were displayed where X-rays were carried out as required by the 2000 IRMER regulations. Emergency medicines and equipment was suitable and checked for efficiency and to ensure they did not go beyond their expiry dates. Sufficient quantities of equipment were available at the practice and were serviced and maintained at regular intervals.

There were sufficient numbers of well qualified staff working at the practice.  Staff had received safeguarding training and were aware of their responsibilities regarding safeguarding children and vulnerable adults. There was an identified lead at the practice for safeguarding and appropriate policies and procedures in place.

Effective

No action required

Updated 6 April 2016

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

The practice specialised in orthodontic treatment for straightening teeth. Patients received an assessment of their dental needs including recording and assessing their medical history. Explanations were given to patients in a way they understood and risks, benefits, options and costs were fully explained and consented to. The practice kept detailed dental records of oral health assessments; treatment carried out and monitored outcomes of treatment.

National Institute for Health and Care Excellence (NICE), British Orthodontic Society’s guidance, Department of Health, national best practice and clinical guidelines were considered in the delivery of orthodontic care and treatment for patients. The treatment provided for patients was effective, evidence based and focussed on the needs of the individual.

The staff were appropriately trained in delivering the specialised services they provided. Staff were registered with the General Dental Council (GDC) and were meeting the requirements of their professional registration.

Caring

No action required

Updated 6 April 2016

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

Patients were treated with dignity and respect and their privacy maintained. Patients spoke highly of the care and treatment given. We found that treatment was clearly explained and patients were provided with information regarding their treatment and oral health. Staff were highlighted to special needs or medical conditions of patients through a flagging system on the computer which helped them treat patients individually and with care and understanding.

Patients who were nervous or anxious about attending the dentist were cared for with compassion that helped them feel more at ease.

Responsive

No action required

Updated 6 April 2016

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

The practice was aware of the needs of their patients and took these into account in how the practice was run. Patients had good access to appointments at the practice. There were good dental facilities in the practice and there was sufficient well maintained equipment to meet patients’ needs. Appointment times were convenient and met the needs of patients and they were seen promptly. The practice was accessible and accommodated patients with a disability or lack of mobility. Treatment areas and a disabled accessible toilet were located on the ground floor. There was ramp access to the ground floor.

There was a clear complaints system in place.

Well-led

No action required

Updated 6 April 2016

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

There was an effective leadership structure evident and staff felt well supported by the principal dentist and management. Staff were supported to maintain their professional development and skills. Staff attended documented meetings and had discussions to review aspects of the delivery of dental care and treatment and the management of the practice. Patients and staff were able to feedback compliments and concerns regarding the service.

The practice had governance and risk management structures in place. Clinical audits took place. Health and safety risks had been identified and risk assessments were in place and reviewed.