Updated 30 October 2023
We carried out this announced comprehensive inspection on 20 September 2023 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 practice was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations.
The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental advisor.
To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:
- The dental clinic appeared clean, tidy and well-maintained.
- The practice had infection control procedures which reflected published guidance.
- Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
- The practice had systems to manage risks for patients, staff, equipment and the premises. The inspection highlighted some additional risks which the provider quickly responded to.
- Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The practice had staff recruitment procedures which reflected current legislation.
- Clinical staff provided patients’ care and treatment in line with current guidelines.
- Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
- Staff provided preventive care and supported patients to ensure better oral health.
- The appointment system worked efficiently to respond to patients’ needs.
- The frequency of appointments was agreed between the dentist and the patient, giving due regard to National Institute of Health and Care Excellence (NICE) guidelines.
- There was effective leadership and a culture of continuous improvement.
- Staff felt involved, supported and worked as a team.
- Staff and patients were asked for feedback about the services provided.
- Complaints were dealt with positively and efficiently.
- The practice had information governance arrangements.
Background
Bridgewater Dental Surgery is in Bridgewater, Manchester and provides private dental care and treatment for adults and children.
There is step free access to the practice for people who use wheelchairs and those with pushchairs. A free public car park, including dedicated parking for disabled people, is located across the road from the dental practice. The practice has made reasonable adjustments to support patients with access requirements. Cars can be parked directly outside the premises by prior arrangement with the practice.
The dental team includes 1 dentist, 1 dental nurse and 1 receptionist/patient coordinator. The practice has 1 treatment room.
During the inspection we spoke with the dentist, the dental nurse and the receptionist. We looked at practice policies, procedures and other records to assess how the service is managed.
The practice is open:
Monday 2pm to 5.30pm
Tuesday 9am to 1pm
Thursday 9am to 1pm
Friday 9am to 1pm
The practice can accommodate requests for appointments outside these hours by prior arrangement.
The practice is closed on Wednesdays and weekends. However, the telephone is answered from 8am to 10pm every day.
There were areas where the provider could make improvements. They should:
- Take action to implement any recommendations in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’
- Implement an effective recruitment procedure to ensure that appropriate Disclosure and Barring Service checks or a risk assessment are completed prior to new staff commencing employment at the practice.
- Implement an effective system for investigating and reviewing accidents, incidents and significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
- Improve the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained. In particular, where engineer’s reports have recommended actions.