07/12/2017
During an inspection looking at part of the service
We carried out this announced responsive inspection on 7 December 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 Cheshire and Merseyside area team that we were inspecting the practice. We did not receive any information of concern from them.
We reviewed the practice against two of the five questions we ask about services: is the service safe and well-led?
These questions formed the framework for the areas we looked 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 well-led?
We found that this practice was providing well-led care in accordance with the relevant regulations.
Background
Hale Road Dental Practice is located in a residential suburb of Liverpool and provides dental care and treatment to adults and children on an NHS and privately funded basis.
The provider has installed a ramp to facilitate access to the practice for wheelchair users. The practice has 3 treatment rooms. Car parking is available near the practice.
The dental team includes a principal dentist, four associate dentists, five dental nurses and a receptionist. The team is supported by a practice manager, who is also a registered dental nurse
The practice is owned by a company and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Hale Road Dental Practice is the principal dentist.
During the inspection we spoke to the principal dentist, dental nurses and the practice manager. We looked at practice policies, procedures and other records about how the service is managed.
The practice is open:
Monday to Wednesday 8.00am to 5.30pm
Thursday 9.00am to 5.30pm
Friday 9.00am to 4.00pm.
Our key findings were:
- The practice was clean and well maintained.
- The practice had infection control procedures in place which reflected published guidance.
- Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available.
- The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
- The practice had staff recruitment procedures in place.
- Staff provided patients’ care and treatment in line with current guidelines.
- The practice had procedures in place for dealing with whistleblowing concerns and complaints.
- Staff took care to protect patients’ privacy and personal information.
- The practice had a leadership structure. Staff felt involved and supported and worked well as a team.
- The practice asked patients and staff for feedback about the services they provided.
- The practice had systems in place to help them manage risk. Risk assessments were not in place for two clinical staff in relation to the effectiveness of the Hepatitis B vaccination.
There were areas where the provider could make improvements and should:
- Review the practice’s system to ensure it is effective in assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities, specifically in relation to staff immunity to Hepatitis B.