Hill House Dental Surgery

We carried out this announced inspection on 2 October 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 not providing well-led care in accordance with the relevant regulations.

Background

Hill House Dental Surgery is in Langport and provides NHS dental treatment to adults and children with a private paying service for treatment with the hygienist.

There is level access for people who use wheelchairs and those with pushchairs. Although some assistance may be provided where required. There is on-street parking available near the practice.

The dental team includes three dentists, four qualified dental nurses and one trainee, one dental hygienists, and two receptionists. The practice has three 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 Hill House Dental Surgery is the main partner.

On the day of inspection, we collected 59 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with two dentists, including the principal dentist, one dental nurse, the dental hygienist and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 8am-5pm

Tuesday 8am-6pm

Wednesday 9am-6pm

Thursday 9am-5pm

Friday 9am-5pm

Our key findings were:

• The practice appeared clean and well maintained.
• Staff felt involved and supported and worked well as a team.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• 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 new leadership and new systems in place to help continuously improve the practice. These needed to be embedded.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had information governance arrangements. However, did need to improve how they secured patient and staff information.
• The provider had infection control procedures which reflected published guidance. Although, procedures for dealing with spillages were not included.
• Staff knew how to deal with emergencies. However, some staff were overdue their training. Appropriate medicines were available. However, there was some life saving equipment missing.
• Staff recruitment procedures needed to improve to ensure staff were safely recruited.
• The provider had systems to help them manage risk to patients and staff. However, these required improvements. This included; risk assessing sharps, control of substances hazardous to health and managing the effectiveness of staff immunity to hepatitis B.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure specified information is available regarding each person employed

Full details of the regulations the provider is not meeting are at the end of this report.

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

• Take action to ensure clinicians record in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Take action to ensure all clinicians are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Take action to ensure the clinicians take into account the guidance provided by the Faculty of General Dental Practice when completing dental care records.
• Take action to ensure the clinicians adopt an individual risk based approach to patient recalls taking into account the National Institute for Health and Care Excellence guidelines.