We carried out an announced comprehensive inspection on 15 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 not providing well-led care in accordance with the relevant regulations.
Background
Stewart House Orthodontic Surgery is a well-established dental practice that provides primarily NHS orthodontic treatment to children. The team consists of an orthodontist, two trainee dental nurses and a receptionist. The practice has a treatment room, an x-ray room and reception/waiting area. It opens from 8.30 am to 4.30pmon Monday to Fridays.
The practice owner is registered with the Care Quality Commission (CQC) as an individual. 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.
Before the inspection we sent comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 24 patients who commented positively about the quality of the service and the effectiveness of their treatment.
Our key findings were:
- Patients were treated in a way that they liked and were actively involved in decisions about their treatment.
- There were arrangements in place for identifying, recording and managing risks and implementing mitigating actions
- The practice was visibly clean and equipment was well maintained.
- Patients’ care and treatment was planned and delivered in line with evidence-based guidelines, best practice and current legislation. Patient dental care records were detailed and comprehensive.
- The practice listened to its patients and staff and acted upon their feedback.
- The practice’s staff recruitment procedures and infection prevention and control practices needed to be strengthened.
- There was lack of an effective audit systems in place to ensure that a good service was being delivered to patients.
- Staff did not receive regular appraisal of their performance.
We identified regulations that were not being met and the provider must:
- Ensure effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and national guidance relevant to dental practice. This must include ensuring the safe recruitment of staff, responding to national safety alerts, implementing robust infection control procedures and undertaking effective audits of the service provided.
There were areas where the provider could make improvements and should:
- Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.
- Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
- Review the training, learning and development needs of staff members and implement an effective process for the on-going assessment and appraisal of all staff employed.
- Review the practice’s protocols for recording in the patients’ dental care records or elsewhere 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.