Blackbrook Dental Practice

We carried out this announced inspection on 8 August 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

Blackbrook Dental Practice received a comprehensive inspection on 31 January 2017 and we served a requirement notice for regulation 17 good governance. They required improvement in ensuring the service was assessed and monitored to ensure risks were mitigated and they improved the quality and safety of services provided. This included the taking actions following risk assessments carried out for health and safety and fire safety. They also had some areas where they should improve and we reviewed these areas. This included having an annual infection control statement in place.

The inspection was led by a CQC inspector who had access to a remote specialist dental adviser.

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. During this inspection we reviewed the relevant parts of the well-led key question to check if they were now meeting our standards.

Our findings were:

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Blackbrook Dental Practice is in Taunton and provides NHS and private treatment to patients of all ages.

There is level access for patients who use wheelchairs and pushchairs. Car parking spaces, including two for patients with disabled badges, are available near the practice.

The dental team includes five dentists, one dental hygienist, one qualified dental nurse and six trainee dental nurses. The trainee dental nurse job role also includes reception cover. The practice has four treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Blackbrook Dental Practice was the practice manager.

During the inspection we spoke with the practice manager and looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday, Wednesday and Thursday - 8:15am to 5:15pm
• Tuesday - 8:15am to 7pm
• Friday - 8:15am to 4:15pm

Our key findings were:

• The practice had taken action and addressed issues identified within risk assessments to ensure risks were mitigated. This included fire safety, health and safety and legionella.
• There were processes in place to ensure infection control procedures were met including the completion of an annual infection control statement.
• Daily checks were recorded to show unpackaged instruments were reprocessed at the end of the working day.
• The practice had effective leadership. The manager had made changes to ensure staff felt involved and supported and worked well as a team.

We carried out an announced comprehensive inspection on 31 January 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

Blackbrook Dental Practice is situated in a modern purpose built building in a residential area and close to bus routes. The practice provides NHS general and restorative dental services to children and adults and some private patients.

The facilities include four surgeries and a purpose built, dedicated decontamination/ sterilisation room plus spacious waiting areas. The facilities are fully equipped to cater for people of all ages and abilities. Children are made welcome. The practice has wheel chair access to the three ground floor surgeries. There is a hearing loop at reception and information materials can be provided in large font. Access to translation services is available on request.

Fees for both NHS and private were displayed in information leaflets for patients available in the practice and on the practice website. 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 which can be accessed by calling NHS 111. These arrangements were displayed in the practice and on a telephone answering service.

At the time of the inspection the practice did not have a registered manager in post. 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.

The practice is open Monday, Wednesday and Thursday 8.15am to 5.15pm, Tuesday 8.15am to 7.00pm, Friday 8.15am to 4.15pm. The service is closed at weekends but offers an Out of Hours service via the local NHS community dental services.

We reviewed 10 CQC comment cards that had been left for patients to complete prior to our visit. In addition we spoke with six patients on the day of our inspection.

Feedback from patients was positive about the care they received from the practice. They commented the 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. Patients we spoke with and the comment cards told us staff were kind, caring, competent and put patients at their ease. Three patients spoke of the fast turnover of staff especially at reception.

Our key findings were:

• There were systems in place to help ensure the safety of staff and patients but some were not operated effectively. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies.
• We observed and were told by staff the practice ethos provided patient centred dental care in a relaxed and friendly environment.
• Leadership had been lacking until two weeks prior to the inspection when a new practice manger had commenced in post.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The dental practice did not have effectively operated clinical governance and risk management processes in place for health and safety.
• Patient care and treatment was delivered in line with evidence-based guidelines, best practice and current legislation including National Institute for Care Excellence (NICE) guidelines.
• Patient dental care records were electronic, detailed and comprehensive.
• The practice had a system to monitor and improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.
• The use of digital radiographs to help explain necessary treatment to patients while in the chair.
• Premises appeared well maintained and visibly clean. Good cleaning and infection control systems were mostly in place. The treatment rooms were well organised and equipped, with good light and ventilation.

• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.
• Staff were up to date with current guidelines, supported in their professional development and the practice was led by a proactive principal dentist.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required with information for out of Hours service clearly available.
• Staff received training appropriate to their roles and were supported in their continuing professional development (CPD) by the company.
• Staff we spoke with were committed to providing a quality service to their patients but had not felt well support until the very recent arrival of the new manager.

There were areas where the provider could make improvements and MUST:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities including fire and health and safety.

There were areas where the provider could make improvements and SHOULD:

• Review the practice infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance with particular attention to the Annual Infection Control statement.