We carried out an announced comprehensive inspection on 15 May 2018 at Bupa Health and Dental Centre - Reading to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Bupa Health and Dental Centre - Reading provides independent health assessment services, GP consultations and musculoskeletal services. This inspection focused on the independent health assessments and GP consultations. The dental service report, which was inspected on the same day, can be found by selecting the ‘all reports’ link for Bupa Health and Dental Centre on our website at www.cqc.org.uk

We obtained patient feedback through 23 comments cards which were all positive about the service.

Our key findings were:

• The provider had systems and processes to provide safe care and treatment.
• The provider had suitable arrangements for dealing with medical and other emergencies.
• Staff assessed patients’ needs and provided care and treatment in line with recognised guidance.
• Patients were positive about all aspects of the service the provider provided.
• Staff protected patients’ privacy and were aware of the importance of confidentiality.
• The provider’s appointment system was efficient and met patients’ needs.
• The provider had arrangements to ensure the smooth running of the service.
• There was a clearly defined management structure and staff felt supported and appreciated.
• The provider monitored clinical and non-clinical areas of their work to help them improve and learn.
• Risks to patients were managed and mitigated.

The areas where the provider should make improvements are:

• Review the policy on identity checking to ensure risks to patients are mitigated.

Professor Steve Field (CBE FRCP FFPH FRCGP) Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 26 January 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

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

Are services well-led?

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

Background

Bupa Health and Dental Centre, Reading provides independent health assessment services which include occupational health services, GP consultations and blood testing services. The service has an in-house dental suite offering preventive, specialist and cosmetic dental and hygienist services.

Services are provided from 7.30am to 6pm Monday to Friday and from 8.30am to 5pm on alternate Saturdays. Dental patients requiring advice and support outside of those hours are advised to use the NHS 111 service. The service does not manage the ongoing of care and review of patients with long term conditions as part of its GP services.

The centre employs 22 staff and an additional 11 staff provide services on a sessional basis. These include health assessment and primary care doctors, health advisors, sport and exercise medicine consultants, physiotherapists, a dental nurse and dental hygienist and dentists. Those staff are supported by the centre manager and a range of administration and support staff.

The centre manager 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 service is run.

As part of our inspection we asked for CQC comment cards to be completed by patients prior to our inspection and we spoke to some patients on the day of our inspection. 13 patients provided feedback about the service. All of the comments were positive about the care they had received. Patients told us that staff acted in a professional manner and they felt they received good standards of care.

Our key findings were:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients and staff were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Services were provided in a well-equipped and well maintained environment.
• Staff had received training appropriate to their roles and further training needs had been identified and planned. However, staff were only trained by Bupa to level 2 in the safeguarding of children. Decontamination training for some dental staff was overdue but this had been planned.
• Staff received regular supervision and appraisal of their performance.
• Staff worked closely with other health care professionals to ensure patients’ needs were met.
• Staff had some understanding of the Mental Capacity Act 2005 but this was not consistent across the staff team.
• There were processes to ensure infection control processes were implemented. However, improved arrangements were required for the storage of clinical waste awaiting collection.
• Information about services and how to complain was available and easy to understand.
• The provider was aware of, and complied with, the requirements of the Duty of Candour.
• All staff were highly aware of the vision and ethos of the organisation and shared a commitment to continuous improvement.

There were areas where the provider could make improvements and should:

• Ensure improved arrangements for the safe and secure storage of clinical waste awaiting collection.
• Review arrangements for the location of emergency medicines within the centre. 
• Implement risk assessment processes to ensure staff receive training in the safeguarding of children at a level appropriate to their role. 
• Provide more comprehensive training in the Mental Capacity Act 2005 in order to improve knowledge and understanding across the staff team.
• Ensure updated decontamination training for dental staff is completed.

A single inspector conducted the inspection and helped to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, from speaking with people who use the service, speaking with the staff and from looking at records. We spoke with two people after they had had their appointments.

Is the service safe?

We saw that people were treated with respect and dignity by the staff. People came to the reception and were received by staff who were courteous and helpful. One person told us that the staff were good at communicating and listened to what they had to say.

For each person risk factors were identified as part of their health assessment and they were provided with a treatment plan and information to reduce the risks and improve their health. There were also general risk assessments with measures to reduce risk and keep the people who used the service and the staff safe. There was emergency contingency equipment and medication to make sure that people were kept safe if there was a medical emergency.

There were systems to make sure that managers and staff learned from events such as accidents, incidents and concerns. This reduced the risks to people and helped the service to improve continually.

The general environment and the treatment rooms were clean and tidy. There were hand-washing facilities for staff and there were cleaning schedules and decontamination procedures to reduce the risk of infection.

There were enough staff so that they were not rushed and could respond to people calmly. This helped to make sure that people’s needs were always met. Staff had a range of qualifications so that they had the right skills to provide a range of services and to keep people safe.

The health and safety representative conducted a monthly check to make sure that the service was safe.

Is the service effective?

People’s health and needs were assessed and each person had a detailed treatment plan to improve their health. People were asked to give their consent to assessment and treatment and signed a form to show their consent. Both people we spoke with said that they had given their consent to assessment and treatment.

The health assessments and dental examinations identified potential risks to people’s health. People were given advice to improve their health and if necessary a referral was made to another service which could provide support and treatment. The assessments identified when people may be at risk of developing a long term condition.

The centre had a range of staff with appropriate qualifications and training including doctors, health care advisors, a dentist, hygienist and physiotherapist. Staff updated their training so that they had the knowledge and skill to offer effective treatment and advice.

Is the service caring?

People were treated with respect and courtesy. One person told us that communication was very good and the doctor and health advisor listened to what they had to say. The doctor and health advisor gave them advice about how to keep healthy and manage health conditions.

There was also written information for people about different health conditions. People were supported through advice and their treatment plans to manage their own health and wellbeing and to maximise their independence.

Is the service responsive?

The appointment system was straightforward so that people could access the service easily. People could access assessment, advice and treatment at a time to suit them.

The service was planned to take account of different needs in relation to age, gender, disability, culture and religion. For example there were separate toilets and changing rooms for men and women, these were disability friendly and there were signs in the reception and consulting rooms offering a chaperone.

People could give their views about the service through a monthly survey and where shortfalls or concerns were raised these were addressed.

People knew how to make a complaint if they were unhappy. There had been one recent complaint about an administrative error and the computer system had been simplified to make sure this did not happen again.

Is the service well-led?

The service worked well with other agencies such as GPs and hospital staff to make sure people received their care in a joined up way.

The service had a quality assurance system so that the quality of the service was continually audited and monitored. We saw records, which showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff we spoke with were clear about their roles and responsibilities. There were clear lines of accountability with a lead manager for each area of the service. For example there was a dental team manager, infection control lead and an overall manager for the service. The manager told us that a senior manager in the organisation monitored the quality of the service.

People told us they were pleased with the care provided by the health advisors and doctors at the BUPA Centre. They said staff were professional and knowledgeable. They were provided with information about their treatment and felt comfortable asking for more information. Where complaints were made, people told us they were dealt with promptly and professionally.

We found that people using the service were provided with appropriate care to meet their needs. Care and treatment were provided by trained and competent staff. There were systems for monitoring the quality and safety of services provided to people which included collecting feedback from patients. Where improvements to services were required, these were made.

However, there were inadequate systems in place for preventing and controlling the spread of infection. There was no evidence policies and procedures were developed in reference to the Code of Practice on the prevention and control of infections and related guidance, under the Health and Social Care Act 2008.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

We saw the reception area was welcoming and well organised and the receptionist was friendly and courteous. At the time of our visit we were unable to speak with patients using the service about their experience. However, the results of the most recent survey conducted by Ipsos MORI for August 2011, concluded that 74% of 86 patients were either extremely satisfied or very satisfied with the overall quality of service provided. The majority would either definitely or very likely recommend the service to others.

We carried out this announced inspection on 15 May 2018 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.

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

Bupa Health and Dental Centre provide private dental treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including allocated parking for disabled patients, are available in the car park at the rear of the practice.

The dental team includes two dentists, of which one is also a specialist orthodontist, two dental hygienists, three dental nurses, one visiting trainee dental nurse, a Saturday receptionist and a practice manager who also covers reception duties. The practice has two treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission 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 practice is run. The registered manager at Bupa Health and Dental Centre is the centre manager.

On the day of inspection we collected 21 CQC comment cards filled in by patients and obtained the views of five other patients.

During the inspection we spoke with a dentist, hygienist a practice nurse and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open 8am to 5pm Monday, 8am to 5.30pm Tuesday 8.30am to 5.30pm Wednesday to Friday and 8.30 to 4.30pm on Saturday.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported 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 suitable information governance arrangements