Updated 4 July 2018
We carried out an announced follow-up inspection at Mr I T Burrell Dental Surgery on 6 June 2018.
We had undertaken an announced comprehensive inspection of this service on the 23 August 2017 as part of our regulatory functions where a breach of legal requirements was found.
After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to those requirements. We checked whether they had followed their action plan to confirm that they now met the legal requirements.
We reviewed the practice against one of the five questions we ask about services: are the services well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mr I T Burrell Dental Surgery on our website at www.cqc.org.uk.
We revisited Mr I T Burrell Dental Surgery as part of this review and checked whether they now met the legal requirements. We carried out this announced inspection on 6 June 2018 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 asked the following question
• Is it well-led?
This question forms the framework for the areas we look at during the inspection.
Our findings were:
Are services well-led?
We found that this practice was providing well-led care in accordance with the relevant regulations.
Background
Mr I T Burrell Dental Surgery is in Grimsby and provides NHS treatment to patients of all ages.
There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.
The dental team includes four dentists, a dental hygienist, eight dental nurses, a decontamination assistant, two receptionists and a practice manager (who is also a qualified dental nurse). The practice has six treatment rooms.
The practice is owned by an individual who owns the practice. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.
During the inspection we spoke with one dentist, one dental nurse, the decontamination lead, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday to Thursday from 9:00am to 5:30pm
Friday from 9:00am to 3:00pm
Our key findings were:
- Improvements had been made to the processes for managing risks associated with fire, Control of Substances Hazardous to Health (COSHH), X-ray equipment and the safe use of sharps.
- A system had been put in place to report significant events.
- Improvements had been made to the recruitment process.
- Governance processes were now in place to support the smooth running of the service.
- Audits of infection prevention and control and radiography had been completed.