Cape Road Dental Practice

We carried out this announced inspection on 2 July 2019 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.

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 providing well-led care in accordance with the relevant regulations.

Background

Cape Road Dental Practice is in a residential area in Warwick and provides NHS and private treatment to adults and children. The services are provided under two Care Quality Commission registered providers at this location. This report only relates to the provision of general dental care provided by Cape Road Dental Practice. An additional report is available in respect of the general dental care services which are registered under Cape Road Dental Practice Limited.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available for two hours in the streets surrounding the practice. Car parking spaces for blue badge holders, are available in pay and display car parks near the practice.

The dental team includes six dentists, five dental nurses, three dental hygienists, a treatment plan co-ordinator, three receptionists and a practice manager. The practice has six treatment rooms.

The practice is owned by a partnership 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 Cape Road Dental Practice is one of the two principal dentists.

On the day of inspection, we collected 90 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, two dental nurses, the treatment plan co-ordinator 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 to Thursday from 8am to 5.30pm.

Friday from 8am to 2pm.

Our key findings were:

• At the time of our visit the practice was undergoing significant building works to expand the premises and facilities on offer for patients. The work was due for completion by September 2019 and renovation improvements included an additional surgery upstairs, a ground floor office, a communications room and a dental laboratory.
• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were mostly available except for some sizes of face masks for the self-inflating bags and a size zero oropharyngeal airway. These items were ordered and placed in the emergency kit within 48 hours of our inspection.
• The provider had systems to help them manage risk to patients and staff. The practice did not provide a five-year fixed electrical wire test certificate and the annual portable appliance visual checks had not been completed since April 2017. These were scheduled for completion following our inspection. Sentinel tap water temperature checks had not been recorded in line with the legionella risk assessment, this was immediately rectified within 48 hours of our inspection.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Safeguarding contact details and flow charts were displayed in the staff room.
• The provider had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment mostly in line with current guidelines. Clinical records did not detail the risks and benefits of treatment options discussed with patients. This had recently been identified by the practice manager following a record card audit and they were putting processes in place to rectify this with the clinicians.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information. Building works included a communications room to ensure that receptionists on the front desk could focus on dealing with patients within the practice and the team in the communications room could take all incoming calls confidentially.
• Staff provided preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs. The practice offered extended hours appointments opening from 8am Monday to Friday.
• The provider had effective leadership and culture of continuous improvement. In house training for basic life support and online training was funded by the provider.
• Staff felt involved and supported and worked well as a team. Staff we spoke with told us they enjoyed their work and were proud to work at the practice.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

There were areas where the provider could make improvements. They should:

• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular ensuring that five-yearly fixed electrical wire testing, the annual visual inspections for portable appliances and monthly sentinel tap water temperature checks are completed within appropriate timeframes.
• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.