Updated 24 March 2020
We carried out this announced inspection on 16 January 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 and the CQC clinical fellow for dentistry.
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 service was providing safe care in accordance with the relevant regulations.
Are services effective?
We found this service was providing effective care in accordance with the relevant regulations.
Are services caring?
We found this service was providing caring services in accordance with the relevant regulations.
Are services responsive?
We found this service was providing responsive care in accordance with the relevant regulations.
Are services well-led?
We found this service was providing well-led care in accordance with the relevant regulations.
Background
Grace Dental Care is in Stockton on Tees and provides a specialist referral service for patients between the age of three and 80 who require conscious sedation. The majority of treatment is provided by the NHS, private treatment is available upon request. The service is located within the outpatient department of North Tees Hospital.
There is level access to the service for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for people with disabilities, are available in the hospital care park.
The team includes eight dentists, nine consultant anaesthetists, seven dental nurses, three receptionists and a practice manager. The service has two treatment rooms and dedicated recovery areas.
The service is owned by a partnership and as a condition of registration must have a person registered with the CQC 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 service is run. The registered manager at Grace Dental Care is one of the consultant anaesthetists.
On the day of inspection, we collected 50 CQC comment cards filled in by patients.
During the inspection we spoke with two dentists, two dental nurses, two consultant anaesthetists, two receptionists and the practice manager. We looked at policies and procedures and other records about how the service is managed.
The service is open:
Monday to Friday from 8:30am to 5:30pm
Saturday from 8:30am to 1:00pm
Our key findings were:
- The premises 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. Appropriate medicines and life-saving equipment were available.
- The provider had systems to help them manage risk to patients and staff.
- The staff knew their responsibilities for safeguarding vulnerable adults and children. There was no vulnerable adult safeguarding policy in place.
- The provider had staff recruitment procedures which reflected current legislation. Improvements could be made to the process for recording verbal references.
- The clinical staff provided patients’ care and treatment in line with current guidelines. Improvements could be made to the sedation process to bring in line with nationally recognised guidance.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The appointment system took account of patients’ needs.
- The provider had effective leadership and a culture of continuous improvement.
- 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 had information governance arrangements.
There were areas where the provider could make improvements. They should:
- Improve the practice’s safeguarding policy and ensure it takes into account both vulnerable adults and children.
- Implement an effective recruitment procedure to ensure that references are completed prior to new staff commencing employment at the practice.
- Improve the practice's complaint handling procedures and establish a system for recording verbal complaints made by service users.
- Implement protocols for conscious sedation, taking into account the guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015. In particular, the recording of patients’ blood pressure before and after treatment.