Updated 29 January 2020
We carried out this announced inspection on 16 December 2019 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.
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 practice was providing safe care in accordance with the relevant regulations.
Are services effective?
We found this practice was providing effective care in accordance with the relevant regulations.
Are services caring?
We found this practice was providing caring services in accordance with the relevant regulations.
Are services responsive?
We found this practice was providing responsive care in accordance with the relevant regulations.
Are services well-led?
We found this practice was providing well-led care in accordance with the relevant regulations.
Background
Church View Dental Care is in Leeds and provides NHS and private dental care and treatment for adults and children.
The practice is located on the first floor of the premises, there is a stair lift to help patients who cannot manage the stairs. Car parking spaces are available near the practice.
The dental team includes six dentists, nine dental nurses, one dental hygienist, two dental hygiene therapists, three receptionists and a practice manager. The practice has six treatment rooms.
The practice is owned by a company 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 practice is run. The registered manager at Church View Dental Care is the principal dentist.
On the day of inspection, we collected 49 CQC comment cards filled in by patients.
During the inspection we spoke with three dentists, two dental nurses, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday from 8:30am to 6:00pm
Tuesday from 8:00am to 6:30pm
Wednesday from 9:00am to 5:00pm
Thursday from 8:00am to 5:00pm
Friday from 8:00am to 3:00pm
Our key findings were:
- The practice was visibly clean and hygienic.
- 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. Improvements could be made to the process for managing risks associated with the use of radiography equipment and for fire safety.
- The provider had safeguarding processes in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The provider had staff recruitment procedures which reflected current legislation.
- 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.
- Staff provided preventive care and supported patients to ensure better oral health.
- 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 dealt with complaints positively and efficiently.
- The provider had information governance arrangements.
There were areas where the provider could make improvements. They should:
- Improve the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017.
- Take action to ensure ongoing fire safety management is effective.
- Improve the practice's systems for ensuring that all equipment is well maintained.
- Implement a system to ensure patient referrals to other dental or health care professionals are centrally monitored to ensure they are received in a timely manner and not rejected.