We carried out an announced comprehensive inspection on 9 August 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
Chatsworth House Dental Clinic, Harrogate, North Yorkshire. It is a NHS and private dental practice which offers private dental payment plans. The practice offers dental treatments including preventative advice and general dentistry.
The practice has three surgeries, one on the ground floor and two on the first floor, a decontamination room, two waiting areas, a reception area and patient toilets. There are staff facilities on the second floor of the premises.
There are three dentists, five dental nurses (one of which is a trainee) and a practice manager. The partners who own the practice provide support for human resources, payroll and practice management including risk assessments and health and safety.
The practice is open between the hours of 8am and 6pm; opening and closing hours varying from day to day throughout the week.
The principal dentist 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.
On the day of inspection we received 46 CQC comment cards providing feedback and spoke with eight patients. The patients who provided feedback were very positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be friendly, caring and welcoming especially on reception. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment.
Our key findings were:
- Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it. They had good systems in place to work closely and share information with the local safeguarding team.
- There were sufficient numbers of suitably qualified staff to meet the needs of patients.
- Staff had been trained to manage medical emergencies.
- Patient care and treatment was planned and delivered in line with evidence based guidelines and current regulations.
- We found a limited application of guidance issued in the publication 'Delivering better oral health: an evidence-based toolkit for prevention' when providing preventive oral health care and advice to patients.
- Patients were treated with dignity and respect and confidentiality was maintained.
- There was a complaints system in place. Staff recorded complaints and cascaded learning to staff.
- The governance systems were not effective.
- The practice sought feedback from staff and patients about the services. There was a clear leadership structure and staff felt supported by the practice manager but not by other management. The practice proactively sought feedback from staff and patients.
We identified regulations that were not being met and the provider must:
- Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD) and ensure that all staff had undertaken relevant training, to an appropriate level, in safeguarding of children and vulnerable adults. Ensure that systems and processes are established and operated effectively to safeguard patients from abuse and review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
- Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
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’s protocols for recording the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
- Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
- Review dental care records, giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
- Review the practice protocols giving due regard to National Institute for Health and Care Excellence (NICE) guidelines.