14 February 2023
During a routine inspection
We carried out this announced comprehensive inspection on 14 February 2023 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 adviser.
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 was visibly clean and well-maintained.
- The practice had infection control procedures which reflected published guidance.
- Staff knew how to deal with medical emergencies. Not all emergency medical equipment had expiry dates recorded, it was therefore difficult to identify whether these items had passed their expiry date.
- The practice had some systems to help them manage risk to patients and staff, although minor shortfalls were identified in relation to fire safety, legionella management and prescription monitoring.
- Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The practice had staff recruitment procedures which reflected current legislation.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Patients were treated with dignity and respect and staff took care to protect their privacy and personal information.
- Staff provided preventive care and supported patients to ensure better oral health.
- The appointment system took account of patients’ needs.
- There was effective leadership and 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.
- Complaints were dealt with positively and efficiently.
- The dental clinic had information governance arrangements.
Background
The provider has 69 practices and this report is about Bhandal Dental Practice, Tile Hill Health Centre.
Bhandal Dental Practice, Tile Hill Health Centre is in Coventry and provides NHS and private dental care and treatment for adults and children.
The dental practice is situated on the first floor of a health centre with a passenger lift for people who use wheelchairs and those with pushchairs. Stairs are also available to access the practice. Car parking spaces, including dedicated parking for disabled people, are available in a car park a short distance from the practice.
The dental team includes 1 dentist, 2 dental nurses (including a trainee dental nurse), 1 receptionist and 1 practice manager. The practice has 1 treatment room.
During the inspection we spoke with 1 dentist, 2 dental nurses, the receptionist and the practice manager. The Business Manager and a receptionist from another local Bhandal practice were also in attendance to assist during this inspection. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday to Friday from 9am until 6pm
There were areas where the provider could make improvements. They should:
- Take action to ensure the availability of medicines and equipment in the practice to manage medical emergencies taking into account the guidelines issued by the British National Formulary, the General Dental Council and the Resuscitation Council (UK).
- Improve the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
- Take action to implement any recommendations in the practice’s fire safety risk assessment and ensure ongoing fire safety management is effective.
- Take action to implement any recommendations in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance, In particular monitor and log hot and cold water temperatures ensuring that they are in line with the recommended temperature range.