We carried out this announced inspection on 30 May and 31 May 2017 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, who was a dentist. The inspection was carried out over two days because there were two individual providers based on one site.
We told the NHS England area team and Healthwatch that we were inspecting the practice. They provided information which we took into account.
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 not providing well-led care in accordance with the relevant regulations.
Background
Hanham High Street Dental Practice is in Hanham in South Gloucestershire and provides NHS and private treatment to patients of all ages.
There is no level access for patients who use wheelchairs and there is no allocated parking for patients. Patients can use public transport services to attend the practice and there is a short stay car park nearby.
The dental team includes three dentists, five dental nurses and three receptionists. The practice has three treatment rooms.
The practice is owned by an individual who is the principal dentist. They 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 collected 45 CQC comment cards filled in by patients and spoke with five other patients. This information gave us a positive view of the practice.
During the inspection we spoke with three dentists, three dental nurses, a trainee dental nurse, two receptionists 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 and Wednesday 9am – 5pm
- Tuesday and Thursday 9am – 6pm
- Fridays 8am – 4pm
Our key findings were:
- The practice was clean and well maintained.
- The practice had infection control procedures which reflected published guidance.
- Staff knew how to deal with emergencies and appropriate medicines and life-saving equipment were available. Systems in place to check the emergency equipment must be improved.
- The practice had ineffective systems to help them manage risk.
- The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- The practice must improve staff recruitment procedures.
- Through the review of patient records it was not always clear that clinical staff had followed current guidelines when providing care and treatment.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The appointment system met patients’ needs.
- The provider needed to improve its leadership to ensure it improved upon patient safety and governance within the practice. Staff felt involved and supported by the practice manager and worked well as a team.
- The practice asked staff and patients for feedback about the services they provided.
- The practice dealt with complaints positively and efficiently.
We identified regulations the provider was not meeting. They must:
- Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. For example, completing actions from the fire safety risk assessment, ensuring emergency equipment was in working order, ensuring all staff reviewed the COSHH file, ensuring the consent policy included Mental Capacity Act and Gillick competency. Ensure there is an effective system in place to monitor staff training. Ensure there is an effective system in place to ensure staff maintain patient confidentiality at all times. Ensure there is an effective audit trail in place to monitor prescriptions upon entry to when they leave the practice. Ensure there is an effective system in place to respond to all patient comments including NHS choices.
- 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.
- Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
- Ensure the practice’s protocols for recording in the patients’ dental care records or elsewhere the justification 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.
Full details of the regulations the provider was not meeting are at the end of this report.
There were areas where the provider could make improvements. They should:
- Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society
- Review staffing arrangements to ensure all staff received appraisals and the support they required for their role.
- Review the storage of records related to people employed and the management of regulated activities giving due regard to current legislation and guidance.
- Introduce protocols regarding the prescribing and recording of antibiotic medicines in consideration of guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing
- Review dental care records so that they are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.