Exeter Dental Education Facility

We carried out this announced comprehensive inspection on 15 June 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 facility 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 educational facility appeared clean and well-maintained.
• There were infection control procedures which reflected published guidance.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
• There were systems to manage risks for patients, staff, equipment and the premises.
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The dental educational facility had staff recruitment procedures which reflected current legislation.
• Clinical staff provided patients’ care and treatment in line with current guidelines.
• Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system worked efficiently to respond to patients’ needs.
• There was effective leadership and a culture of continuous improvement.
• Staff felt involved, 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 educational facility had information governance arrangements.

Background

The provider is a social enterprise and there are 4 dental educational facilities within the group, all located in the South West. This report is about Exeter Dental Educational Facility.

Exeter Dental Educational Facility is in Exeter. Adult patients are triaged and can receive one course of dental treatment and are then discharged. Paediatric patients are accepted between the ages of 1 and 13 and are not triaged. Dental treatment is provided by dental students from the University of Plymouth School of Dentistry, who work under the supervision of qualified dental professionals. Treatment is not available to patients undergoing an active course of treatment with an NHS dentist. There is no charge for treatment.

There is step free access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made reasonable adjustments to support patients with access requirements.

The dental team consists of dental educational facility directors, a senior management team, clinical and educational leads, dentists, dental nurses, a dental hygienist therapist, a clinical lab technician, administrative staff, maintenance staff and reception staff. There are annual cohorts of dental students, dental therapy and hygiene students and dental nurse apprentices receiving training at the facility. The dental educational facility works in conjunction with Plymouth University. There are 41 dental chairs.

During the inspection we spoke with a range of staff from the Dental Educational Facility and the University, which included directors, senior managers, clinical staff and administrative staff and the registered manager. We looked at practice policies, procedures and other records to assess how the service is managed.

The dental educational facility is open: Monday to Friday 9.00am – 5.00pm (during term times).

We noted innovative approaches to providing person centred care. For example, members of the clinical team, with special interests in paediatric dentistry had developed a chairside synopsis for antimicrobial prescribing in dentistry, for common conditions in children. This was available as a companion to national Good Practice guidelines for adult prescribing. The standard was approved for use by the College of General Dentistry and was soon to be published in the prestigious British Dental Journal - Nature.

In addition, the senior management team had developed and introduced a local safety standard for dental student antimicrobial prescribing. The clear and simple checklist was used for each prescription and ensured national antimicrobial guidance was followed, recorded and approved by the students’ clinical supervisor. Included was a prompt to review the medication efficiency between 2 – 7 days later, or a record of why this was not required. The checklist was able to be used by qualified clinical staff too, as an aide memoire for good practice and as evidence to support the termly antimicrobial prescribing audits.

The practice had taken steps to improve environmental sustainability. For example, there was a sustainability co-ordinator working at the facility. Secure bike racks were available for patients or staff choosing to cycle to the facility. Students are offered transport to the facility via coach, therefore reducing road congestion. There were recycling points throughout the building and water machines for refilling water bottles at the reception area and in the waiting rooms. There was a mainly digital workflow to reduce paper waste.

We identified an area of notable practice.

• The facility had a disability access statement on its website. The statement detailed adaptations made to promote inclusivity at the facility. There was clear information, with photographs, about the internal and external facility, including listed physical dimensions information for wheelchair or mobility scooter users and details about flooring finishes, and any kerbs, stairs or inclines. Information was included regarding signage, lighting, adaptations to reduce sensory overload and locations of emergency call points. Bathroom facility information was recorded and there was information regarding the processes when welcoming assistance dogs. Interpreter services, and information available in alternative formats was explained and a reassurance that staff had received disability awareness training. The access statement helped patients and visitors who may have physical disability, learning disability, sensory impairment, or additional other needs plan for their visit. During the inspection we saw inclusivity put into practice, for example, all patients were asked if they had additional needs during the initial triage process to put adaptations in place for a successful visit. We believe this to be notable practice and is worth sharing.