Bridge Dental Practice

We carried out this announced inspection on 10 March 2020 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 Care Quality Commission (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 this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

Bridge Dental Practice is in Towcester, a market town in Northamptonshire. It provides NHS and private dental care and treatment for adults and children. Services include general dentistry.

There is level access to the practice for people who use wheelchairs and those with pushchairs. Car parking spaces for patients are available in local car parks within short distance of the premises. There is a dedicated parking space for people with disabilities in a shared private car park.

The dental team includes five dentists, four dental nurses, one sterilisation assistant, one dental hygienist, one dental hygiene therapist, one receptionist and a business manager. The practice has four treatment rooms; one of which is on ground floor level. There is also a separate decontamination room.

The practice is owned by an individual who is the principal dentist there. 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.

On the day of inspection, we collected 44 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two dental nurses, the sterilisation assistant, the dental hygiene therapist, the receptionist and the business 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 Friday from 8am to 6pm.

Our key findings were:

• The practice appeared to be visibly clean and well-maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Not all of the appropriate medicines and life-saving equipment were available, however. The provider took action to address some of the issues we identified immediately after our inspection.
• The provider had some effective systems to help them manage risk to patients and staff. We noted areas where improvement was required to mitigate risks.
• The provider had a safeguarding policy and staff had completed training. We found systems were not working effectively as not all staff demonstrated awareness of their responsibilities for safeguarding vulnerable adults and children. The provider took immediate action to address concerns after our inspection.
• The provider had staff recruitment procedures, but not all staff recruitment files reflected current legislative requirements in relation to references or other evidence of previous satisfactory conduct being held.
• 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.
• Staff felt involved and supported and worked as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently. It was not evident that learning outcomes were shared with staff as this was not sufficiently documented.
• Governance arrangements required strengthening.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure that persons employed for the purposes of carrying on a regulated activity are fit and proper persons.

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

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

• Implement a system to ensure private patient referrals to other dental or health care professionals are monitored to ensure they are received in a timely manner.
• Improve the security of NHS prescription pads in the practice to ensure there are systems in place to track and monitor their use.
• Improve the practice’s arrangements for ensuring good governance and leadership are sustained in the longer term.