Smith and Associates

We carried out this announced comprehensive inspection on 15 November 2022 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 and well-maintained.
• The practice had infection control procedures; these did not fully reflect national guidance.
• Staff knew how to deal with medical emergencies. Medicines and life-saving equipment were available however these were not in line with national recommendations. Items that were missing, or not in the recommended format, were ordered on the inspection day and evidence was sent to us.
• The practice had systems to manage risk to patients and staff; these needed to be reviewed to ensure they were effective.
• Safeguarding processes were in place; staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice had staff recruitment procedures which did not reflect current legislation, in particular documents were not held for all recruitment checks undertaken by the provider.
• The appointment system took account of patients’ needs.
• Clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff provided preventive care and supported patients to ensure better oral health.
• Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
• The dental clinic had information governance arrangements.
• Existing governance systems did not assist the practice to meet national recommendations or provide a culture of continuous improvement.
• Staff felt involved and supported and worked as a team.
• Staff and patients were asked for feedback about the services provided. Improvements could be made to the systems for responding to, and acting on, feedback from external websites.
• Complaints were dealt with positively and efficiently.

Background

Smith and Associates is in Hartlepool and provides NHS and private dental care and treatment for adults and children.

There are steps in front of the practice which may restrict access for people who use wheelchairs and those with pushchairs. To overcome this, staff assist patients with the stairs, or refer them to a sister practice nearby which has step-free access. Car parking spaces are available near the practice. The practice has made reasonable adjustments to support patients with additional needs, including installing a hand-rail and coloured striping near the front steps, and availability of a hearing loop at reception.

The dental team includes a principal dentist, 2 associate dentists, a locum dentist, 9 dental nurses, a dental therapist and 4 receptionists. A practice manager and a nurse manager collectively oversee the governance of the practice. The practice has 5 treatment rooms.

During the inspection we spoke with 2 dentists, 2 dental nurses, the nurse manager and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday 9am to 5pm

Friday 9am to 4.30pm.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

Full details of the regulation the provider was not meeting is at the end of this report.

There were areas where the provider could make improvements. They should:

• Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment. In particular, ensure audits of image quality assurance is undertaken for the orthopantomogram X-ray machine.
• Implement processes and systems for seeking and learning from patient feedback with a view to monitoring and improving the quality of the service.