We carried out an announced comprehensive inspection on 3 September 2015 to ask the practice the following key questions: Are services safe, effective, caring, responsive and well-led?
Our findings were:
Are services safe?
We found that this practice was not 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 not providing well-led care in accordance with the relevant regulations.
Dorset House Dental Surgery provides mainly NHS dental treatment although staff told us they also carry out a small amount of private treatment. The practice is situated in a residential area of Rugby not far from the town centre.
Dorset House has 5 dentists, two of whom are the partnership which owns the practice. Some of the dentists work part time. There are four dental hygienists, four dental nurses and two trainee dental nurses. The clinical team are supported by two reception staff. There had not been a practice manager in post for a year and the partners had not been able to recruit a suitable candidate. In July 2015 the partners had started to use a dental practice consultant to provide part time management input and guidance.
The practice has six dental treatment rooms and a decontamination room for the cleaning, sterilising and packing of dental instruments. The reception area and waiting room are on the ground floor.
Before the inspection we sent Care Quality Commission comment cards to the practice for patients to use to tell us about their experience of the practice. We collected 46 completed cards. These provided a positive view of the service the practice provides. Patients were very complimentary about the whole practice team who they described using words such as kind, friendly, professional and helpful. Several patients specifically mentioned that the reception team were pleasant and courteous. The practice showed us the results of their 2015 NHS Friends and Family Test monthly surveys for April to August 2015. These showed that from 373 responses 239 patients were ‘extremely likely’ to recommend the practice and 107 were ‘likely’ to do so. Of the remainder 23 were neutral about this or didn’t know. Only three said they’ were unlikely’ to recommend the practice and one ‘extremely unlikely’ to do so.
Our key findings were:
- Patients who completed Care Quality Commission comment cards were pleased with the care and treatment they received and complimentary about the whole practice team.
- The practice did not have established process for reporting and recording significant events or accidents to ensure they investigated these and took remedial action. There was no evidence of learning when adverse incidents happened.
- The practice was visibly clean and a number of patients commented on their satisfaction with hygiene and cleanliness. The décor, including flooring required refurbishment.
- The practice had systems to assess and manage infection prevention and control (IPC) but some aspects of these needed to be reviewed and strengthened.
- Some staff lacked confidence in respect of the processes to follow in the event of a medical emergency.
- The practice had safeguarding processes and staff understood their responsibilities for safeguarding adults and children.
- Recruitment policies and procedures did not fully reflect the requirements of legislation to ensure that all of the required checks for new staff were completed.
- The content of dental care records was brief, but included the essential information expected about patients’ care and treatment.
- Staff received training appropriate to their roles and were supported in their continued professional development (CPD) but the practice did not have a structured process to monitor this.
- Patients were able to make routine and emergency appointments when needed.
- The practice did not have fully established and effective systems to assess, monitor and improve the quality and safety of the services provided.
- The practice did not have fully established and effective systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
We identified regulations that were not being met and the provider must:
- Ensure that care and treatment is provided in a safe way by taking reasonably practicable steps to mitigate any risks including following good practice guidance and adopting control measures to make sure any risks are as low as reasonably possible.
- Establish an effective process for recording accidents and other significant events to ensure that remedial action and learning takes place when adverse incidents occur.
- Establish an effective process for recording and sharing national and local information and guidance about best practice and alerts about patient safety.
- Ensure the practice’s infection control procedures and protocols are reviewed giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum
01-05, ‘Decontamination in primary care dental practices’ and The Health and Social Care Act 2008, ‘Code of Practice on the prevention and control of infections and related guidance’
- Establish an effective system to assess, monitor and improve the quality and safety of the services provided.
- Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.
You can see full details of the regulations not being met at the end of this report.
There were areas where the provider could make improvements and should:
- Review availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
- In addition to annual staff training in basic life support, ensure that staff have opportunities for updates and shared learning at the practice to maintain their knowledge, skills and confidence in dealing with any medical emergency that may arise.
- Provide suitable arrangements for the disposal of sanitary waste in staff and patient toilets and for the disposal of clinical waste in the decontamination room.
- Have in place a clear policy and procedures in respect of precautions against legionella including water testing in line with Health and Safety Executive guidance.
- Review recruitment procedures to reflect the requirements of Regulation 19(3) and Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014. The recruitment policy should include an assessment of which staff will require a Disclosure and Barring Service check.
- Review the health and safety assessment commissioned by the practice and update the action plan to establish which actions have not yet been completed and arrange for any necessary work, including in relation to fire safety, to be carried out.
- Make more detailed records of the care and treatment provided to patients and ensure that the use of X-rays is suitably audited and recorded.
- Check that the partners’ professional indemnity cover also provides cover for all the dental nurses or advise the dental nurses to arrange individual cover.
- Record informal verbal complaints raised by patients to ensure that these can be used to contribute towards staff learning and reviewed to ensure they have been considered and actioned when appropriate.
- Develop clear working protocols for the use of practice facilities and infection prevention and control in relation to the external dental implant specialist who had begun to see patients from the practice.
- Tailor all policies and procedures to the specific circumstances at Dorset House and fully adopt these as working documents to support the effective management of the practice.
- Have statutory records and records relevant to the management of the practice available at the practice at all times.
- Put in place arrangements to ensure effective governance and cohesive long term leadership at the practice.