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Glastonbury Dental Access Centre

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Updated 17 March 2016

We carried out an announced comprehensive inspection on 08 September 2015 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found this centre was not providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

We found this centre was not providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this centre was not providing well-led care in accordance with the relevant regulations.

Background

The Glastonbury dental access centre is situated in the centre of Glastonbury town. The centre has three dental treatment rooms, a decontamination room for the cleaning, sterilising and packing of dental instruments and a reception and waiting area. Services are provided on two floors. The main entrance to the centre is accessible by external steps with an electric stair lift for wheelchair patients although this does have a weight limitation. The centre is open Monday to Friday 8.30am – 12.30pm & 1.30pm - 5.00pm.

Glastonbury Dental Access Centre has two dentists and two dental nurses and a part time Dental Therapist. The centre manager and clinical team are supported by one receptionist. Satellite services are provided at Frome but this was not inspected. The access centre is also supported by an Oral Health Promotion team operating from the Burnham-on-Sea satellite clinic.

The service provides NHS oral healthcare and dental treatment for children and adults that have an impairment, disability and/or complex medical condition. People who come into this category are those with a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability, including those who are housebound.

A sedation service is provided where treatment under a local anaesthetic alone is not feasible and conscious sedation is required. The service provides an ‘in-hours’ emergency dental service for those patients who do not have a regular dentist. The service also provides a domiciliary service for those patients unable to access the Glastonbury Dental Access Centre.

Before the inspection we sent Care Quality Commission comment cards to the centre for patients to complete to tell us about their experience of the centre but none had been completed. During the inspection we spoke with seven patients, parents and carer’s five staff and the centre manager who is the senior dental nurse. The patients we spoke with were very complimentary about the service. They told us they found the centre and staff provided excellent and highly professional care; were extremely friendly and welcoming and all patients felt they were treated with dignity and respect.

Our key findings were:

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment during their appointments.

  • There were comprehensive policies and procedures identified at the centre, however we found some of these were incomplete namely the IRMER file and equipment maintenance logs. We were advised the ‘missing’ information was at the trust HQ in Bridgwater.

  • We observed staff were passionate about working within the service and providing good quality care for patients. We saw evidence of service improvement initiatives and regular monitoring of the quality of the service with audits of infection control and radiographs.

  • There was a strong commitment across the staff team to providing co-ordinated and responsive assessments and treatment for patients.

  • Services were organised so they meet patient’s needs.

  • The location had effective local clinical leadership provided by an experienced Senior Dental Officer with extensive experience in special care dentistry. Staff followed current professional guidelines in areas of special care dentistry, and conscious sedation when caring for patients.

  • Staff had received training appropriate to their roles and were supported in their continuing professional development.

  • Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available. However, emergency equipment used for domiciliary visits required review to ensure it was meeting appropriate national guidelines to ensure risks to these patients were reduced and patients kept safe if an emergency arose.

  • Infection control procedures were comprehensive and the centre followed published guidance. The environment was visibly clean and well maintained and patients told us they felt the premises were clean.

  • Effective safeguarding processes were in place for safeguarding vulnerable children and adults and staff fully understood the implications of the Mental Capacity Act 2005.

  • The centre had good facilities including disabled access. However we noted the electric stair lift had weight limitations.

We identified regulations that were not being met and the provider must:

  • Ensure the cleaning contractor conforms to published National Patient Safety Association (NPSA) regarding cleaning of dental premises.

  • Rectify the 18 defects noted in the Legionella risk assessment carried out 10 December 2013.

  • Ensure when carrying out domiciliary visits they take appropriate emergency equipment as advised by the British Society for Disability and Oral Health (BSDH) August 2009.
  • Ensure immunisation status is recorded for all staff who have received hepatitis B immunisation as directed by the Code of Practice on the prevention and control of infections, appendix D criterion 9(f).
  • Ensure staff were recruited safely according to the Trust recruitment policy and Schedule 3 of the Health and Social Care Act 2008. Particularly ensuring references and gaps in employment were evidenced during the recruitment process.
  • Ensure all equipment is regularly serviced in line with approved guidance.

For full details of the regulations not being met please refer to the Somerset Partnership NHS Foundation Trust report dated 7-11 September 2015 – Community and Specialist Dental Services in order to see the areas for which requirement notices were issued.

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

  • Ensure the centre manager and senior clinician are empowered to make local decisions in the best interest of Glastonbury access centre.

  • The whistle blowing policy did not include information about who staff could raise concerns with externally such as the Care Quality Commission (CQC).

Inspection areas

Safe

Improvements required

Updated 17 March 2016

We found this access centre was not providing safe care in accordance with the relevant regulations. We have told the provider to take action (see full details in the Somerset Partnership NHS Foundation Trust Community Dental Services report).

Systems, processes and practices were in place to ensure all care and treatment was carried out safely. Lessons were learned and improvements were made when things went wrong.

The centre had systems in place to assess and manage risks to patients. They had robust processes in place including infection prevention and control, health and safety, training and the management of medical emergencies.

The centre did not have robust recruitment practices as these were carried out at Trust HQ. We saw no action had been taken to address the high risk areas identified in the Legionella and fire risk assessments. We did not see evidence equipment had been regularly serviced and was safe and fit for use.

Effective

No action required

Updated 17 March 2016

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

Patient’s needs were assessed and care and treatment was delivered in line with current legislation, standards and evidence based guidance. Patients were given time to consider their options and make informed decisions about which treatment option they preferred. The dental care records we looked at were clear and complied with current best practice in dental clinical record keeping.

Staff had the skills, knowledge and experience to deliver effective care and treatment. The centre monitored patient’s oral health and gave appropriate health promotion advice. There were effective arrangements in place for working with other health professionals to ensure effective quality of treatment and care for the patient.

Patient’s consent to care and treatment was always sought in line with legislation and guidance and they were given time to consider their options to make informed decisions about the preferred treatment option. Staff engaged in continuing professional development and were meeting the training requirements of the General Dental Council.

Caring

No action required

Updated 17 March 2016

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

We received positive feedback from patients about the quality of care provided at the access centre. They felt the staff were patient centred and caring; they told us they were treated with dignity and respect at all times. We observed all the staff were passionate about working within the service and providing exceptional quality care for patients.

We found patient records were stored securely and patient confidentiality was well maintained. On the day of inspection we observed privacy and confidentiality was maintained for patients using the service.

Responsive

Improvements required

Updated 17 March 2016

We found this access centre was not providing responsive care in accordance with the relevant regulations.

Services were planned

and delivered to meet the needs of patients. Patients had good access to appointments, including emergency appointments, which were available on the same day.

The needs of patients with disabilities had been considered and arrangements had been made to ensure access to the waiting area and treatment rooms on the first floor.

Patients were invited to provide feedback via a satisfaction survey. We observed a good rapport between staff and patients attending appointments on the day of the inspection. Information about complaints was available for patients and complaints were dealt with appropriately according to the Trust complaint policy.

There was a waiting list for referrals to the centre and for some treatments patients were waiting more than the set standard waiting time. The senior dental officer told us once in the system treatment was completed in a timely manner according to patient risk.

Well-led

Improvements required

Updated 17 March 2016

We found this access centre was not providing care which was well led in accordance with the relevant regulations.

Governance arrangements locally ensured responsibilities were clear, quality and performance were regularly considered. Risks were identified but not always coordinated effectively to ensure recommendations from assessments were addressed promptly. For example, recommendations had not been completed or addressed following a legionella risk assessment to ensure the safety of patients.

A system of audits was used to monitor and improve performance. Feedback from staff and patients was used to monitor and drive improvement in standards of care.

The leadership and culture encouraged openness and transparency and promoted the delivery of high quality care and treatment. Staff corroborated this and told us they were comfortable raising and discussing concerns with the centre manager.

We observed the local leadership from both clinical and non-clinical staff at the location was excellent. However there were issues around the ability of the local leadership being empowered to implement local changes from the Trust for the benefit of patients.

Other CQC inspections of services

Community & mental health inspection reports for Glastonbury Dental Access Centre can be found at Somerset NHS Foundation Trust.