Archived: Kyrle Street Dental Practice

Updated 15 December 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The inspection was carried out on 2 November 2016 by a CQC inspector and a dental specialist adviser. We reviewed information we held about the provider and information that we asked them to send us in advance of the inspection.

During the inspection we spoke with both partners and other dentists, dental nurses and reception staff. We looked around the premises including the treatment rooms. We viewed a range of policies and procedures and other documents and read the comments made by 23 patients in comment cards provided by CQC before the inspection. Two patients contacted us direct by email to provide their positive views about the practice. The practice provided their 2016 NHS Friends and Family Test results.

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 15 December 2016

We carried out an announced comprehensive inspection on 2 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 providing well-led care in accordance with the relevant regulations.

Background

Kyrle Street Dental Practice is situated close to Hereford city centre. It provides mainly NHS dental treatment for all age groups and a small amount of private dental treatment. There has been a dental practice at the premises for over 40 years. The practice has been operated by the current partnership of two dentists for over 20 years.

In January 2016 the Department of Health (DH) announced the launch of a prototype process as the next stage in the reform of NHS dentistry. Kyrle Street Dental Practice is one of 82 practices in England selected to take part in the Dental Prototype Agreement Scheme. They are testing new ways of providing NHS dental care with an increased emphasis on preventing future dental disease.

One of the two partners is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

The practice has seven dentists (including the two partners), a dental hygienist, nine dental nurses and three trainee dental nurses. The registered manager and clinical team are supported by a practice manager, two reception staff and an accounts administrator.

The practice has six dental treatment rooms and a separate decontamination room for the cleaning, sterilising and packing of dental instruments. The waiting room is separate from the reception area which helps provide privacy when staff are dealing with patients at the reception desk or on the telephone. Areas of the practice used by patients are all on the ground floor with level access into and around the building. The nearby public car park has designated spaces for patients with disabilities and the practice has space for patients with disabilities to park immediately in front of the building. There is sufficient space within the building for patients who use wheelchairs including in the patient toilet. The practice provides a wheelchair to support patients if required during their visit?

The practice is open from 8.30am to 5pm Monday to Friday and closes for lunch from 1pm to 2pm.

Before the inspection we sent Care Quality Commission comment cards to the practice so patients could give us their views about Kyrle Street Dental Practice. We collected 23 completed cards. Two patients contacted us direct by email. Patients spoke highly of the service they received and described the practice team as professional, efficient, caring and respectful. Patients who commented on being involved in planning their treatment said their treatment met their needs and that their dentist listened to them. Those who commented on cleanliness confirmed that the practice was clean and tidy. The results of the practice’s NHS Friends and Family Test forms for 2016 to date were positive and showed that 91% of the patients who took part were extremely likely or likely to recommend the practice. Only three of the 66 patients who responded said they would not recommend the practice.

Our key findings were:

• The practice was visibly clean and feedback from patients confirmed this was their experience. National guidance for cleaning, sterilising and storing dental instruments was followed.

• The practice had suitable safeguarding processes and staff understood their responsibilities for safeguarding adults and children.

• The practice had arrangements for dealing with medical emergencies.

• Dental care records provided clear information about patients’ care and treatment and patients received written treatment plans where necessary.
• Staff received training appropriate to their roles and were supported to meet the General Dental Council’s continuous professional development requirements.

• Patients were able to make routine and emergency appointments when needed and were gave us positive feedback about the service they received.

• The practice used the NHS Friends and Family Test, to enable patients to give their views about the practice. Staff had opportunities to contribute their views through daily discussions, staff meetings and annual appraisals.

• The practice had policies and procedures to help them manage the service. Some record keeping needed consolidation to make information easier to access for monitoring and management purposes.

• Recruitment arrangements did not ensure that all the required information was always obtained for staff employed. The practice established a new recruitment policy and process immediately.

• The practice used audit as a means to monitor quality in a range of areas and used repeat audits to ensure improvements had taken place.

There were areas where the provider could make improvements and should:

• Review the availability of a policy regarding the Duty of Candour to support the practice in providing appropriate information to patients directly affected by adverse incidents.
• Review the availability of information about translation services for patients who do not speak English as their first language or who use British Sign Language.

• Review the recording arrangements for some aspects of practice management including incoming safety alert information, fire safety arrangements and staff records.