Further to the outcome of a previous inspection, carried out in May 2015, we carried out an announced focused inspection relating to the clinical governance systems of the location on 17 June 2016 to ask the practice the following key question;

Are services well-led in relation to provision of dental care?

Our findings were:

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations

Background

Ashurst Dental Surgery offers mainly (more than 80%) NHS dental care services to patients of all ages. Approximately 40% of patients attending the practice do not speak English as their first language. Staff spoke a number of languages including Polish, Lithuanian and Russian which supported patients to communicate their needs. The services provided include preventative advice and treatment and routine and restorative dental care. The practice has a treatment room on the ground and one on the first floor of the premises.

The practice has two dentists, one of whom is the principal dentist; a dental nurse, a trainee dental nurse and a receptionist/administrator. The principal dentist 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.

Our key findings were:

All of the requirements set out by the Care Quality Commission in relation to governance at the previous practice inspection had been met:

• An incident reporting policy and system of reporting incidents had been developed and introduced.
• A team based training event for dealing with medical emergencies had been undertaken at the practice.
• A comprehensive health and safety risk assessment had been carried out by the practice to mitigate the risks to patients, staff and visitors.
• A control of substances hazardous to health (COSHH) policy had been introduced to underpin the data sheets in the COSHH file.
• A new system had been put in place to meet the requirements of the Ionising Radiation Regulations 1999.
• Improvements had been made to clinical record keeping.
• The practice had introduced a comprehensive system for capturing and evaluating patient feedback.
• The practice had reviewed their systems for clinical audit and had introduced a rolling programme of audit topics.
• The practice had introduced a system for recording the training that had been undertaken by all members of staff.

We carried out an announced comprehensive inspection on 18 May 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 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.

Ashurst Dental Surgery offers mainly (more than 80%) NHS dental care services to patients of all ages. Approximately 40% of patients attending the practice do not speak English as their first language. Staff spoke a number of languages including Polish, Lithuanian and Russian which supported patients to communicate their needs. The services provided include preventative advice and treatment and routine and restorative dental care. The practice has a treatment room on the ground and one on the first floor of the premises.

The practice has two dentists, one of whom is the principal dentist; a dental nurse, a trainee dental nurse and a receptionist/administrator. The principal dentist 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.

Opening hours are Monday, Tuesday and Thursday from 9.00am to 5.00pm with extended opening hours on a Wednesday until 7.00pm. The practice closes at 3.00pm on Fridays.

We spoke with four patients who used the service on the day of our inspection and reviewed seven completed CQC comment cards. Patients commented staff were caring, helpful and respectful and that they had confidence in the dental services provided.

Our key findings were:

• There were systems in place in the areas of infection control and the management of medical emergencies. However incident reporting, managing substances hazardous to health and seeking advice regarding the safe use of X-ray equipment could be improved.

• Patients were given appropriate verbal and written information to support them to make decisions about the treatment they received. The practice had a range of detailed consent forms for different treatments; in order to provide patients with relevant information
• We reviewed seven CQC comment cards that had been completed by patients and spoke with four patients who used the service on the day of the inspection. Common themes were patients felt they were involved in their treatment, listened to and received good care in a clean environment.
• Staff spoke a number of languages including Polish, Lithuanian and Russian; which supported patients to communicate their needs. Consent forms and medical questionnaires were available in several languages
• Overall we found the practice did not have effective clinical governance and risk management systems in place. For example, they did not audit areas of their practice as part of continuous improvement and learning. Patient care records we looked at were not sufficiently detailed and up to date to reflect the care and treatment provided.

We identified regulations that were not being met and the provider must:

• Assess, monitor and improve the quality and safety of the services provided. This should include a system of auditing areas of their practice as part of continuous improvement and learning.

• Establish and implement a process to regularly Identify, assess and manage risks to the health, welfare and safety of patients, staff and visitors to the practice.

• Ensure accurate and contemporaneous clinical patient records are always maintained.

• The practice must seek and act upon feedback from patients and staff on the services provided to continually evaluate and improve services

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:

• Ensure there is a clear incident reporting system in place relating to the safety of patients and staff members.

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society

• Ensure records are maintained regarding the Control of Substances Hazardous to Health 2002 (COSHH) regulations; and staff are familiar with them.

• Review the arrangements in place for maintaining and servicing autoclaves and the ultrasonic cleaner to ensure they are in working order and working effectively.

• Review the arrangements for seeking advice from a radiation protection advisor (RPA) regarding The Ionising Radiation Regulations 1999 (IRR99

• Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going supervision of all staff.

• Ensure the practice considers the Delivering Better Oral Health guidance regarding the selection criteria for fluoride varnish applications.

We spoke with a range of people about the service. They included, a dentist, dental nurses, dental hygienist/therapist and a patient receiving treatment, in order to gain a balanced overview of what people experienced.

During our discussion with a patient we received positive feedback, telling us she was happy with the care and support shown to her during her course of treatment.

Comments received included:

“I think the dentist is very popular with his patients. Those in the waiting room often have a chat whilst waiting to be called and everyone speaks highly of the dentist. The staff are friendly too.”

“If I wasn’t happy I would change to another dentist, but I have been coming here for ten years now, so I think that shows I am satisfied.”