We carried out an announced comprehensive inspection on 14 January 2016 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 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 not providing well-led care in accordance with the relevant regulations.
Background
The Dentist in Town Ltd provides private dental care and treatment. The principal dentist operates the practice as a limited company and is the sole director and 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.
The dentist is supported by a dental hygienist, two nurses and one receptionist. The practice is located in a pedestrian arcade in the heart of the city centre. There is wheelchair access to the premises and the whole practice is on the ground floor. The premises consist of a reception area, waiting room, two treatment rooms, a decontamination room and accessible toilet facilities. Opening hours are 10am to 5.30pm on Monday, Tuesday, Thursday, 8.30am to 5pm on Wednesday and 8.30am to 4pm on Friday.
Forty-three patients provided feedback about the service. We looked at comment cards patients had completed before the inspection. All information we received from these patients was very complimentary. Patients were positive about their experience and they commented that they were treated with care, respect and dignity. They felt that they were listened to and not rushed and many patients travelled some distance to visit this practice.
Our key findings were:
- An infection control policy was in place and procedures followed mainly reflected published guidance. We highlighted areas for improvement and these were dealt with promptly by the dentist.
- Emergency equipment for dealing with medical emergencies mostly reflected published guidelines. We highlighted areas for improvement and these were all dealt with on the day of our visit.
- The practice had a system in place for recording accidents and adverse incidents at the practice.
- Staff demonstrated knowledge of whistleblowing and were confident they would raise a concern about another staff member’s performance if it was necessary.
- Staff needed training in areas such as safeguarding and medical emergencies.
- Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
- We received feedback from 43 patients and all comments were positive about the practice. Patients felt they received an excellent service, they felt involved in their care and that staff were caring and polite.
- During our visit, we observed staff were friendly, caring and professional.
- The appointment system met the needs of the patients and waiting times were kept to a minimum.
- No complaints had been received at the practice.
- There was a lack of an effective system to assess, monitor and improve the quality of the services provided.
- There was a lack of an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
- The practice was unable to demonstrate compliance with the guidance surrounding X-rays as the information was not accessible on the day of the inspection.
We identified regulations that were not being met and the provider must:
- Ensure they establish an effective system to assess, monitor and improve the quality of services provided.
- Ensure they establish an effective system to assess, monitor and mitigate the risks to the health and safety of patients, staff and visitors.
- Ensure they have a standard check on medicines, recruitment and dental care records.
There were areas where the provider could make improvements and should:
- Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
- Review at appropriate intervals the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.
- Maintain accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal references taken and ensuring recruitment checks, including references, are suitably obtained and recorded.
- Carry out audits of various aspects of the service, such as radiography and dental care records at regular intervals to help improve the quality of service. Practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
- Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
- Implement a system to ensure that certain procedures are documented, such as water temperatures and staff appraisals.