Updated 28 June 2019
We carried out this announced inspection on 30 May 2019 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
The practice is in Stamford, a town in the South-west corner of Lincolnshire. It provides NHS and private treatment to adults and children.
Services include: general dentistry; privately available treatments include orthodontics, implants and periodontics.
There is level access for people who use wheelchairs and those with pushchairs. Limited car parking spaces, including one for blue badge holders, are available in the car park at the front of the premises.
The dental team includes seven dentists, one specialist orthodontist, one periodontist, one implantologist, seven dental nurses, four trainee dental nurses, one dental hygienist, one dental hygiene therapist and seven receptionists. A practice manager and practice co-ordinator are also employed. The practice has six treatment rooms; two are on the ground floor. There is also a separate decontamination room.
The practice is owned by a company 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 Bupa – Ryhall Road, Stamford is the practice manager.
On the day of inspection, we collected nine CQC comment cards filled in by patients.
During the inspection we spoke with four dentists, three dental nurses, the dental hygiene therapist, three receptionists, the practice manager and a member of the management team from the provider’s head office. We looked at practice policies, and procedures, patient feedback and other records about how the service is managed.
The practice is open: Monday to Thursday from 8am to 7pm, Friday from 8am to 6pm and Saturday from 8.30am to 1pm.
Our key findings were:
- The practice appeared clean and well maintained.
- The provider had infection control procedures which reflected published guidance.
- Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The provider had staff recruitment procedures. We found that references were not held on some staff files. The practice had access to support from a dedicated human resources and recruitment team based within the company’s head office.
- 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.
- Staff provided preventive care and supporting patients to ensure better oral health.
- The appointment system took account of patients’ needs.
- The practice was served by a dedicated practice manager. The provider had effective leadership and culture of continuous improvement.
- Staff felt involved and supported and worked well as a team.
- The provider asked staff and patients for feedback about the services they provided.
- The provider dealt with complaints positively and efficiently.
- The provider had suitable information governance arrangements.
There were areas where the provider could make improvements. They should:
- Review the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
- Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
- Review staff awareness of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.