Updated 28 October 2019
We carried out this announced inspection on 9 September 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
Welton Dental Care is in Welton, a village in the West Lindsey district of Lincolnshire. It provides private dental treatment to adults and children.
There is level access for people who use wheelchairs and those with pushchairs with use of a portable ramp. There are no patient car parking facilities on site, but those with wheelchairs and mobility problems can be allocated a parking space in a private car park adjacent to the premises. There is free car parking outside the practice and within short distance of the premises.
The dental team includes one dentist, two dental nurses (one more dental nurse is in the process of being recruited), one dental hygienist and a practice manager. Dental nurses share receptionist duties. The practice has two treatment rooms. One is on the ground floor. There is also a separate decontamination room.
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 Welton Dental Care is the principal dentist.
On the day of inspection, we collected 47 CQC comment cards filled in by patients.
During the inspection we spoke with one dentist, two dental nurses and the practice manager. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.
The practice is open: Monday to Thursday 9am to 5:30pm.
Our key findings were:
- 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 most life-saving equipment were available, except for a child self-inflating bag with reservoir and not all the sizes of clear face masks for self-inflating bag were held. An order was placed after the day to obtain the items.
- The provider had systems to help them manage most risks to patients and staff. We noted some areas that required review, such as a risk assessment for staff whose hepatitis B immunity levels were not known and a lone worker risk assessment.
- The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The provider had not implemented a recruitment policy but had thorough staff recruitment procedures.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and 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.
- The provider had taken ownership of the practice in 2018. There was evidence of effective leadership. They were in the process of developing a culture of continuous improvement.
- Staff felt involved and supported and worked well as a team.
- The provider asked staff and patients for feedback about the services they provided.
- The provider had systems to deal with complaints.
- The provider had suitable information governance arrangements.
There were areas where the provider could make improvements. They should:
- Review guidance regarding basic periodontal examination (BPE) from the British Society of Periodontology, when treating younger children.
- Ensure that X-ray equipment is fitted with rectangular collimation to reduce exposure to patients.
- Improve the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.
- Take action to ensure audits of radiography and infection prevention and control are undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
- Improve the practice’s arrangements for ensuring good governance and leadership are sustained in the longer term.