We carried out an announced comprehensive inspection on 17 March 2017 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 this practice was providing safe care in accordance with the relevant regulations.
Are services effective?
We found this practice was providing effective care in accordance with the relevant regulations.
Are services caring?
We found this practice was providing caring services in accordance with the relevant regulations.
Are services responsive?
We found this practice was providing responsive care in accordance with the relevant regulations.
Are services well-led?
We found this practice was not providing well-led care in accordance with the relevant regulations.
Background
Eurodental Devizes Road Swindon is a dental practice providing mainly NHS treatment for adults and children.
The practice is based on the main road close to local public car parking.
The practice is based on two floors and has five surgeries. The ground floor consists of a waiting area with open reception, one disabled and wheelchair accessible toilet, two treatment rooms and a small but separate room for the , sterilising and packing of dental instruments. There was a separate office for the practice manager and an office behind the reception area for making confidential calls. There was a staff room / kitchen area where the OBG x-ray machine was also located. On the first floor there were a further three surgeries, a separate room for the sterilising and packing of dental instruments and a toilet.
The practice is accessible from Devizes Road and a ramp is located by the front entrance which can be put in place when requested, for people who use a wheelchair. We observed that when cars are parked at the front of the practice access to the front entrance in a wheelchair may be difficult.
The practice employs five dentists, seven dental nurses, two hygienists, two trainee dental nurses, three receptionists and a practice manager.
The practice opens: Monday to Thursday: 8.00am - 5.30pm, Friday: 8.00am - 4.30pm, Saturday: 8.00am – 1pm, Sunday: Closed.
There are arrangements in place to ensure patients receive urgent dental assistance when the practice is closed. This is provided by an out-of-hours service by calling NHS 111.
The practice manager has recently become the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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 Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 19 patients. In addition we spoke with three patients on the day of our inspection. Feedback from patients was positive about the quality of care, the caring nature of all staff and the overall high quality of customer care. They commented that staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained them so they could make an informed decision which gave them confidence in the care provided.
Our key findings were:
- We found that the dentists’ approach to treatment was to provide patient centred dental care in a relaxed and friendly environment.
- Leadership was provided by the practice manager.
- The dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines although we found that an audit of radiographs was overdue.
- Premises appeared well maintained and visibly clean.
- Infection control procedures followed published guidance although the infection control decontamination policy did not fully reflect the current equipment in use. A small number of instruments were found in drawers unpouched. We also noted that separate sinks were not allocated for manual scrubbing of instruments and hand washing in some treatment rooms.
- Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
- Although the dentists provided effective clinical care leading to good patient outcomes, there were shortfalls in the governance systems and processes. This included policies that were either not available, or had not been reviewed and updated to reflect current personnel, equipment or organisations.
- There were systems in place to check all equipment had been serviced regularly, including the autoclaves and X-ray equipment.
- Patients could access treatment and urgent and emergency care when required.
- Information from 19 completed Care Quality Commission (CQC) comment cards and speaking to patients gave us a positive picture of a friendly, caring and professional service.
- The practice carried out pre-employment recruitment checks but these were not always fully completed and there was no recruitment policy which clearly set out the required process and checks for all staff.
- The staff had received training relevant to their role but the arrangements for identifying the ongoing learning and development needs of staff members and the on-going assessment and supervision of all staff employed was not well established.
- A safeguarding policy was in place but needed to be reviewed to reflect current guidance as there was no named lead professional and the practice could not demonstrate that all staff had undertaken training in child and adult safeguarding.
- The practice reviewed and dealt with complaints according to their practice policy.
- The whistleblowing policy in place needed to be reviewed to reflect current guidance.
- The practice was developing information for patients and their arrangements for patient feedback.
- The practice made referrals as appropriate to other primary and secondary care providers such as for specialist orthodontic treatment or hospital services for further investigations or treatment as required, although we found that patients were not always provided with a copy of the referral letter.
- The fridge temperature for products and medicines requiring fridge storage was not regularly monitored or suitably recorded.
- The last fire safety risk assessment was carried out in 2010.
- There was no annual statement available in relation to infection prevention and control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
- The practice had not carried out an access assessment under the Equality Act 2010 but this was planned.
We identified regulations that were not being met and the provider MUST:
- Ensure effective systems are established to assess, monitor, improve the quality and safety of the services provided and mitigate the various risks arising from undertaking the regulated activities.
There were areas where the provider could make improvements and SHOULD:
- Review the practice’s infection control policy to include provision of an annual statement in relation to infection prevention control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance and ensure it reflects equipment used in the practice.
- Review the local operational policies and procedures.
- Review the need for a documented operational policy and procedure for managing medical emergencies and frequency of equipment checks.
- Review the practice safeguarding policy to include the nominated lead professional, alignment with current guidance and staff training in safeguarding.
- Review the recruitment process and consider the development of a recruitment policy.
- Review the provision for copying referral letters to patients.
- Review the provision of an up to date fire safety risk assessment.