At a previous inspection in September 2015 we found that there were shortfalls in a number of areas of the clinical governance systems of the practice. We carried out an announced responsive comprehensive inspection on 16 May 2016 to check that these shortfalls had been addressed and 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 providing well-led care in accordance with the relevant regulations

Background

Dental Care Falmer is a general dental practice which is situated within the campus of Sussex University in Falmer, East Sussex. The practice offers NHS and private dental treatment to adults and children. The practice has two dental treatment rooms, a decontamination room for the cleaning, sterilising and packing of dental instruments and a waiting area. All areas of the practice are located on the ground floor enabling access for patients with mobility difficulties.

The practice is open Monday to Friday 9.00 to 5.00pm. Dental Care Falmer has one dentist who on the day of our visit was supported by a dental nurse and a receptionist. Other staff included a part-time dental hygienist and a practice manager.

One of the practice owners 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. The registered manager is supported in their role by the practice manager.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 23 patients and an additional three patients on the day of our visit. These provided a positive view of the services the practice provides. Patients commented on the high quality of care provided by the dentists, the friendly nature of all staff and the cleanliness of the practice.

Our key findings were:

• The practice philosophy was to provide friendly patient centred care.
• Staff had been trained to handle emergencies, appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• Infection control procedures were in place and the practice followed published guidance.
• The practice had a safeguarding lead and processes in place for safeguarding adults and children living in vulnerable circumstances.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• The dentist provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment as well as urgent and emergency care when required.
• Staff recruitment files contained essential information in relation to Regulation 18, Schedule 3 of Health & Social Care Act 2008 (Regulated Activities) Regulations 2015.
• Staff had received training appropriate to their roles and were supported in their continued professional development by the practice manager.
• Information from 23 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly and professional service.
• We saw that the practice reviewed and dealt with written complaints according to their practice policy.

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

• Review the availability of hearing loops for patients who are hard of hearing
• Consider providing the hygienist with the support of an appropriately trained member of the dental team.
• Consider the provision of an annual infection prevention control statement in accordance with The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Implement a system of regular appraisals for all staff at the practice.
• Update the practices’ details on the NHS Choices website including responding to patient feedback.
• Consider obtaining support in relation to the practice manager role through professional organisations within the dental sector.
• Review the health and safety risk assessment process so that the risk assessment is personalised to the practice.
• Consider updating the control of substances hazardous to health (COSHH) file.

We carried out an announced comprehensive inspection on 1 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.

Dental Care Falmer is a general dental practice which is situated within the campus of Sussex University in Falmer, East Sussex. The practice offers NHS and private dental treatment to adults and children.

The practice has two dental treatment rooms, a decontamination room for the cleaning, sterilising and packing of dental instruments, a reception area and a waiting area. All areas of the practice are located on the ground floor. The main entrance and all other areas of the practice are fully accessible for patients with mobility difficulties.

The practice is open Monday to Friday 9.00 to 5.00pm. The practice does not offer Saturday appointments at present.

Dental Care Falmer has one dentist, one dental nurse and one hygienist. The clinical team are supported by a practice manager and a receptionist.

Before the inspection we sent CQC comments cards to the practice for patients to complete to tell us about their experience of the practice. We collected 17 completed cards. All of the comments cards provided a positive view of the service the practice provides. Patients commented that staff were helpful, friendly and respectful. Patients wrote that they were given the right advice and care. Several patients also commented that the environment was safe and hygienic. We also spoke with four patients during our inspection who were satisfied with the treatment and support they received at the practice.

Our key findings were:

• Patients were satisfied with the treatment they received and were complimentary about staff at the practice.
• There were some systems in place to reduce the risk and spread of infection.
• Most of the staff at the practice maintained the necessary skills and competence to support the needs of patients. However, the practice manager had not undertaken any training courses within the last year.
• We observed that staff showed a caring approach towards patients arriving at reception.
• The practice did not have a robust system in place to collect patient feedback.
• The provider did not have the necessary recruitment documentation in place, including interview notes, application forms, proof of identification and references.
• We were unable to review multiple documents and records that we required on the day of inspection as these could not be located by staff.
• Staff had not received recent appraisals or supervisions.

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

• Ensure a review of systems that are in place to detect, prevent and control the spread of healthcare associated infections, with particular regards to the correct positioning of sharps bins and the transportation of used instruments.
• Ensure recruitment records include all of the necessary employment checks for all staff, including Disclosure and Barring Service checks (DBS), interview notes and references.
• Ensure all members of staff maintain the necessary skills and competence to support the needs of patients.
• Ensure all relevant records and documentation are fully accessible and can be located promptly when required.
• Implement a robust system of collecting and analysing patient feedback in order to take patient’s comments and views into account.
• Implement a robust system to respond to concerns and complaints raised by patients.

• Ensure a full legionella risk assessment is undertaken at the practice.

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 the current Health and Safety and sharps guidelines (2013) in relation to the handling of sharps.
• Consider the use of rubber dam kits in accordance with current guidelines.
• Consider the use of a log to record the checking of emergency medicines and equipment.
• Implement a secure system for the storage of prescription pads.
• Implement regular staff meetings including the recording of staff meeting minutes.
• Maintain up to date training records and schedules for all members of staff at the practice.
• Implement a system of regular appraisals and/ or supervisions for all staff at the practice.
• Implement a process of the review of all policies and protocols in order to reflect current guidelines, along with a robust policy review system. This includes the COSHH file.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.
• Consider Mental Capacity Act 2005 training for relevant members of staff.