Updated 3 July 2017
We carried out this announced inspection on 26 May 2017 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.
We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information which we took into account.
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
Frampton Dental Practice is in Frampton Cotterell and provides NHS and private treatment to patients of all ages.
Access for people who use wheelchairs and pushchairs is via a small step or portable ramp. There are a small number of car parking spaces at the front of the practice or local on street car parking near the practice.
The dental team includes three dentists and an orthodontist, six dental nurses and one trainee dental nurse, two dental hygienists, and three receptionists. The practice has three treatment rooms.
The practice is owned by an individual who is a dentist but who does not work on a day to day basis in the practice. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. One of the principal dentists is the 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.
On the day of inspection we collected 50 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.
During the inspection we spoke with two dentists, two dental nurses, two receptionists, the practice manager and owner. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open: Monday 9am to 1pm and 2pm to 7pm, Tuesday to Friday 9am to 1pm and 2pm to 5.30pm. Saturday and Sunday: Closed
Our key findings were:
- The practice was clean and well maintained.
- The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children, although some staff were due to have safeguarding training in the near future.
- The practice had thorough staff recruitment procedures.
- Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
- The appointment system met patients’ needs.
- The practice had effective leadership. Staff felt involved and worked well as a team.
- The practice asked staff and patients for feedback about the services they provided.
- The practice dealt with complaints positively and efficiently.
- The practice had systems to help them manage risk.
- The practice had protocols for record keeping but we found that medical history updates were not always recorded in the records.
- The clinical staff provided patients’ care and treatment in line with current guidelines although we found that Rubber Dams are not always used during root canal treatment.
- The practice did not always provide patients with a copy of their referral letters.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information but we found that clinical notes stored between the front door and the reception area, were not locked away during opening hours unless the receptionists left the area.
- The practice had infection control procedures which reflected published guidance, although there was no separate room for decontamination and we found that it was not possible to complete the end to end process for decontamination in one of the surgeries. The washing / ultrasonic cleaning was completed in one treatment room. Dental instruments were then transported to another treatment room for packing and sterilisation.
- The practice had not completed an Annual Statement in relation to infection prevention control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
There were areas where the provider could make improvements. They should:
- Review the storage of dental care records to ensure they are stored securely at all times.
- Review the current arrangements for the end to end decontamination process.
- Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
- Review the use of rubber dams in line with guidance from the British Endodontic Society when providing root canal treatment.
- Review the need for an Annual Statement in relation to infection prevention control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
- Review the current staffing arrangements to ensure all dental care professionals 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.