We carried out an announced comprehensive inspection on 28 November 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 not providing well-led care in accordance with the relevant regulations.
Background
Cambridge Street Dental Practice provides NHS dentistry to patients of all ages. A dental hygiene therapist is also available to patients who pay privately for this service. The practice is situated close to the town centre and public parking is nearby. The practice has three dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments. The building is at ground floor level and is has steps at the front door. A portable ramp is available for patients who require this.
The practice opens from 8.30am to 5.30pm Monday to Friday and closes for lunch between 1 and 2pm. The practice has two dentists, a dental hygiene therapist, two dental nurses and a receptionist.
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.
We received feedback from 20 patients who used the service either in person or through the CQC comments cards that had been completed during the two weeks leading up to the inspection visit. Patients provided a positive view of the service the practice provided. All of the patients told us that the quality of care was very good, staff were welcoming and provided them with sufficient information about their dental care and treatment.
Our key findings were:
- Patients told us they were able to get an appointment when they needed one and the staff treated them with respect.
- Information from completed CQC comments cards gave us a positive picture of a friendly, caring and professional service.
- There was appropriate equipment for staff to undertake their duties, and equipment was well maintained. However the practice did not complete regular checks of the emergency equipment.
- Dentists provided dental care in accordance with current guidelines from the Faculty for General Dental Practice guidelines and the National Institute for Care Excellence (NICE)
- A number of safety procedures were in place although these were not always followed to ensure that quality and safety was improved.
- The governance arrangements required improvement to assist with the safe running of the practice. This was because some systems to assess, monitor and improve the quality of the service were not in place or were not working effectively.
We identified regulations that were not being met and the provider must:
- Ensure the practice's recruitment process is in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
- Ensure there are systems and processes in place to assess monitor and improve the quality and safety of the service provided by:
- Ensuring regular monitoring of the work environment in relation to infection control in the treatment and decontamination rooms and ensuring that appropriate cleaning of these areas is completed.
- Ensuring there is an effective process in place for checking the emergency medical equipment and the fridge temperature used to store emergency medicines.
- Implementing a system to communicate quality issues to promote learning and improvement within the staff team.
- Ensure there are systems and processes in place to identify, assess and manage risks in relation to the following:
- Systems for recording, investigating and reviewing accidents, incidents or significant events and for sharing safety alerts
- Monitoring the training, learning and development needs of staff members at appropriate intervals including induction and annual appraisal
- Systems to track the use of prescriptions.
- An effective process to assess, monitor and mitigate health and safety risks including sharps handling procedures in line with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
You can see full details of the regulations not being met at the end of this report.
There were areas where the provider could make improvements and should:
- Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society
- Review staff awareness of Gillick competency and the requirements of the Mental Capacity Act (MCA) 2005 to provide assurance that all staff are aware of their responsibilities.
- Review the availability of an interpreter service for patients who do not speak English as their first language and a hearing induction loop system.
- Review the information about the complaints process to ensure it is accessible to patients.