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Inspection Summary


Overall summary & rating

Updated 24 March 2016

We carried out an announced comprehensive inspection on 8 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

CTL dental practice is located in Richmond, North Yorkshire close to public transport links. The practice has one treatment room on the ground floor, a reception/waiting room, a decontamination room, patient toilets and a staff room and office located on the first floor.

There are two dentists, the owner and an associate, a dental hygiene therapist and three dental nurses (one of which is a trainee).

The practice offers private treatments including preventative advice, periodontal treatment and advanced restorative treatment. There are laser treatment for gum care and endodontic treatments available.

The practice is open various hours over a two week rotation:

Week 1

Monday 10:30 – 20:00, Tuesday 10:00 – 19:00, Wednesday Closed, Thursday 08:00 – 20:00, Friday 19:00 – 21:00, Saturday closed.

Week 2

Monday 10:30 – 20:00, Tuesday Closed, Wednesday 16:00 – 20:00, Thursday 08:00- 20:00, Friday closed, Saturday 08:00 – 13:00.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

On the day of inspection we received 75 CQC comment cards providing feedback. 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 treat them like they care, they had overcome dental phobias since attending the practice, all the staff are professional, exceptional, helpful, and gentle 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.
  • Patient 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 governance systems were effective.
  • The practice sought feedback from staff and patients about the services they provided.

Inspection areas

Safe

No action required

Updated 24 March 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 all care and treatment was carried out safely. For example, there were systems in place for infection prevention and 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 all staff had received a variety of training in infection control. There was a decontamination room with guidance for staff on effective decontamination of dental instruments.

Staff had received training in safeguarding children and vulnerable adults 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 and suitably trained and skilled to meet patients’ needs and there were sufficient numbers of staff available at all times. Staff induction processes were in place and had been completed by all staff. We reviewed the newest member of staff’s induction file and evidence was available to support the policy and process.

We reviewed the legionella risk assessment dated April 2014, evidence of regular water testing was being carried out in accordance with the assessment and monthly dip slip testing was in place.

Effective

No action required

Updated 24 March 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 also 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 dentist was 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 24 March 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 the treatment and care was fully explained to patients in a way which patients understood. Time was given to patients with complex treatment needs to decide what treatment options they preferred.

Comments on the 75 completed CQC comment cards we received included statements saying they were involved in all aspects of their care and found the staff to treat them like they care, they had overcome dental phobias since attending the practice, all the staff are professional, exceptional, helpful, gentle and they were always treated with dignity and respect in a clean and tidy environment.

We observed patients being treated with respect and dignity during interactions at the reception desk and over the telephone. Privacy and confidentiality were maintained for patients using the service on the day of the inspection. We also observed the staff to be welcoming and caring towards the patients.

Responsive

No action required

Updated 24 March 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. If the practice was closed the registered provider had a mobile for patients to contact and they would open the practice if required to see patients in pain.

The practice had good disability access; the surgery was large enough to accommodate a wheelchair and the toilet had an alarm in place if anyone required assistance.

The practice had a complaints process which was 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 24 March 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 and all staff felt supported and appreciated in their own particular roles. The registered provider was responsible for the day to day running of the practice.

The practice held monthly 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 within the guidelines of the National Radiological Protection Board (NRPB).

The practice conducted quarterly patient satisfaction surveys and there was a comments box in the waiting room for patients to make suggestions to the practice.