13 November 2018
During a routine inspection
We carried out this announced inspection on 13 November 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.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?
These questions form the framework for the areas we look 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 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 providing well-led care in accordance with the relevant regulations.
Background
Street Lane Dental Centre is in Moortown on the outskirts of Leeds and is an approved training (for foundation dentists) practice that provides private and NHS dental care to adults and children.
There is ramp access for people who use wheelchairs and those with pushchairs. Car parking is available outside the practice and local transport facilities are nearby.
The dental team includes eight dentists (one of whom is a foundation dentist), two dental hygienists, eight dental nurses, a practice manager and a receptionist. The practice has six treatment rooms.
The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have 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 Street Lane Dental Centre was the practice manager.
On the day of inspection, we collected 23 CQC comment cards filled in by patients. All feedback received was highly positive.
During the inspection we spoke with three dentists, two dental nurses 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 8.30am to 5pm and Friday 8.30 to 4pm.
Our key findings were:
- The practice appeared clean and well maintained.
- The practice had infection control procedures which reflected published guidance.
- Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The practice had good systems to help them manage risk with the exception of fire safety, not all the recommendations had been followed for the fire risk assessments.
- The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- The practice had thorough staff recruitment procedures.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The practice was providing preventive care and supporting patients to ensure better oral health.
- The appointment system met patients’ needs.
- The practice had effective leadership and a culture of continuous improvement,
- Staff felt involved and supported and worked well as a team, had regular staff meetings, we noted that staff appraisals had lapsed.
- The practice asked staff and patients for feedback about the services they provided.
- The practice staff dealt with any complaints positively and efficiently.
- The practice staff had suitable information governance arrangements.
There were areas where the provider could make improvements. They should:
- Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.
- Review the practice's current performance review systems and have an effective process established for the on-going assessment and supervision of all staff.