Archived: Avon House Dental Practice

We carried out an announced comprehensive inspection on 9 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 not providing well-led care in accordance with the relevant regulations.

Background

The practice provides routine dental care for patients of all ages and sees both NHS and private patients. There are two dentists and two dental therapist/hygienists, supported by three dental nurses, a receptionist and practice manager.

The practice has been located on the High Street in Keynsham, Bristol since the 1960s. It is located on the first floor above retail premises and consists of three surgeries, a reception/waiting room, staff room, a decontamination room and separate staff and patient toilets. There is ample on street parking in the area. Opening hours are 9am to 1pm and 2pm to 5.30pm Monday to Friday. The practice is closed at the weekend and patients can access dental care out of hours via a telephone helpline. Access to the practice is via a staircase with twin hand rails and a door bell to alert the reception staff to any patients requiring assistance. Arrangements are in place for those patients who are unable to access the first floor to be seen by other local dental practices. The most recent data (June 2012 to June 2014) indicated the practice saw around 2300 adults and around 800 children as patients.

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

Forty two patients provided feedback about the service, including those who completed CQC comment cards. All the feedback was positive about the practice and the dental care provided. Patients described staff as professional, cheerful, helpful and caring. Patients indicated they were listened to, treatments were explained to them and they received aftercare.

Our key findings were:

• Governance arrangements were in place for the smooth running of the practice; however, the practice did not have a structured plan in place to audit quality and safety. During the inspection the provider identified opportunities to improve governance, such as arranging regular staff meetings where information and learning could be documented and shared more formally.

• The mandatory audit for infection control was incomplete; and the quality of radiographs (X-rays) had not been audited.

• We received consistently positive feedback from patients about the quality of the practice staff, the care received and the effectiveness of their treatment.
• The practice was seen to be clean and tidy; and appeared well organised with instruments correctly stored. There were systems and procedures in place for infection prevention and control. Decontamination procedures in place met the essential requirements as described in the Health Technical Memorandum 01-05.
• Staff had a good understating of the Mental Capacity Act (2005) and the importance of gaining patients informed consent.
• Patients care and treatment was planned and delivered in line with evidence-based guidelines and current legislation. Patients dental care records provided an accurate and contemporaneous record of patient treatments, however, they did not always contain an up to date medical history and there was little evidence of preventative measures to maintain and improve patients oral health.
• There was an effective system in place for reporting and recording significant events, however, it did not ensure learning from them was shared widely with staff.
• Safeguarding patients was given priority within the practice, and staff responded appropriately and professionally to concerns raised.
• Patients received their care and treatment from well-trained and supported staff, who told us they enjoyed their work. They described good team work and an open and positive culture.

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

Ensure audits of various aspects of the service are undertaken at regular intervals to identify shortfalls, mitigate risks and improve the quality of service. This includes ensuring the recording the quality grade of radiographs (X-rays) taken and systems, such as regular audits, to evaluate and improve practice.

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 arrangements for further assessment and referral where high scores for gum disease are found.
• Review the practice protocols and procedures for promoting the maintenance of good oral health to check that they are suitable and adhered to, giving due regard to guidance issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.
• Review dental care records to check they are maintained appropriately, including patient’s medical history, giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review recording of the justification for taking an X-ray and the quality of the X-ray, giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Review the training, learning and development needs of staff members at appropriate intervals and establish an effective process for the on-going assessment and supervision of all staff employed.
• Review the systems and procedures to check all staff have completed mandatory training and appropriate continuing professional development; including checking all staff undertake relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Review the practice recruitment policy and procedures to check they are suitable and recruitment arrangements are in line with Regulation 19.3 and Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including the necessary employment checks and the required specified information is held for all staff.
• Review their responsibilities to meet the needs of patients with a disability and the requirements of the Equality Act 2010 through a Disability Discrimination Act audit.
• Review how learning from accidents and incident is shared with practice staff to mitigate risks and improve safety and quality of service.