Grange Dental Surgery

We carried out this announced comprehensive inspection on 17 April 2024 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 practice was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations.

The inspection was led by a Care Quality Commission (CQC) inspector who was supported by a specialist dental advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:

• The dental clinic appeared clean and well-maintained.
• The practice had staff recruitment procedures which reflected current legislation.
• Patients were treated with dignity and respect.
• Staff provided preventive care and supported patients to ensure better oral health.
• The appointment system worked efficiently to respond to patients’ needs.
• Patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• The practice’s infection control procedures and decontamination room needed improvements.
• Safeguarding processes were in place; however improvements were required to ensure these were up-to-date.
• There were ineffective systems to support continuous improvement.
• The practice did not have effective systems to help them manage risks. These included for example risks related to fire, infection prevention and control, handling of medicines and prescriptions, provision of dental treatment using conscious sedation and handling of sharp instruments.
• The leadership and oversight for the day-to-day management of the service needed improvements.

Background

Grange Dental Surgery is in Snettisham, Norfolk and provides NHS and private dental care and treatment for adults and children.

There is step free access to the practice for people who use wheelchairs and those with pushchairs via the use of a wooden ramp. Car parking spaces, including dedicated parking for disabled people, are available near the practice. The practice has made reasonable adjustments to support patients with access requirements.

The dental team includes 2 dentists, 1 of whom is the principal, 2 dental nurses, 1 dental hygienist, 1 practice manager who is also training to be a dental nurse and 1 receptionist. The practice has 2 treatment rooms.

During the inspection we spoke with both dentists, 3 dental nurses including a locum nurse and the receptionist. We looked at practice policies, procedures and other records to assess how the service is managed.

The practice is open:

Monday to Friday from 8.30am until 5.30pm.

Saturday from 8.30am until 1pm.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

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

• Improve the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum.
• Improve the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Take action to implement any recommendations in the practice's Legionella risk assessment, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’
• Take action to ensure the clinicians take into account the guidance provided by the College of General Dentistry when completing dental care records.
• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the College of General Dentistry.