Archived: Mr Stephen Hambleton - Warley

Updated 26 May 2016

We carried out an announced comprehensive inspection on 11 January 2016 as part of our planned inspection of all dental practices. The inspection took place over one day and was carried out by a lead inspector and a dental specialist adviser.

We informed NHS England area team that we were inspecting the practice, however there were no immediate concerns from them.

During our inspection visit, we reviewed policy documents and staff records. We spoke with six members of staff, including the management team. We conducted a tour of the practice and looked at the storage arrangements for emergency medicines and equipment. We were shown the decontamination procedures for dental instruments. We reviewed comment cards completed by patients and spoke to three patients. Patients gave very positive feedback about their experience at the practice.

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 therefore formed the framework for the areas we looked at during the inspection.

Updated 26 May 2016

We carried out an announced comprehensive inspection on 11 January 2016 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.

Background

Stephen Hambleton Dental Practice has two dentists, one of which works full time and one part time, five qualified dental nurses who are registered with the General Dental Council (GDC), a part time administration assistant and a dental therapist/hygienist. The practice’s opening hours are 9am to 5.30pm Monday to Thursday and 9am to 1pm on Friday. The practice is closed between 1pm – 2pm on Monday to Thursday.

Stephen Hambleton Dental Practice provides NHS and private treatment for adults and children. The practice is located on the first floor of a converted property and has a reception, waiting area and two dental treatment rooms. Decontamination of dental instruments (cleaning, sterilising and packing dental instruments) takes place in each dental treatment room. There is also a reception and waiting area.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

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 collected 73 completed cards and spoke with three patients. These provided an overwhelmingly positive view of the services the practice provides. Patients commented that the quality of care was excellent.

Our key findings were:

• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect.
• The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• Staff had been trained to deal with medical emergencies.
• The practice kept up to date with current guidelines when considering the care and treatment needs of patients.
• Some infection prevention and control systems were in place, although audits were not completed on a six monthly basis.
• Options for treatment were identified and explored and patients said they were involved in making decisions about their treatment.
• Patients’ confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Health promotion advice was given to patients appropriate to their individual needs such as smoking cessation or dietary advice.
• Feedback from 73 patients gave us a positive picture of a friendly, caring and professional service.

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

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. This should include regular clinical audits to assess, monitor and improve the quality and safety of the service and six monthly infection prevention and control audits.

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:

• Implement systems for the reporting and recording of significant events and agree learning outcomes which should be discussed with staff.
• Register with the MHRA to receive medicine safety alerts and ensure that any alerts relevant to the practice are discussed with staff and actions taken as appropriate.
• Implement a system to ensure that the information located in the policies and procedures files is the most up to date information held at the practice.
• Develop a system to demonstrate cleaning undertaken at the practice with records available and ensure that cleaning equipment is stored correctly.
• Develop a robust policy regarding the safe use and disposal of sharps which includes contact details for the local occupational health department.
• Regular staff meetings should be held to discuss any issues within the practice and records should be available to demonstrate discussions held.
• Consider that an accurate, complete and contemporaneous record is kept in respect of each patient, including a record of the decisions taken in relation to the care and treatment provided and justification for taking X-rays.
• Review the way in which patient consent is recorded in dental care records.
• Review at appropriate intervals the training, learning and development needs of individual staff members, ensure that staff have completed relevant training/updates and have an effective process established for staff appraisals.
• Implement systems to demonstrate that smoke detectors are checked to ensure they are in good working order and records kept to demonstrate this.
• Provide evidence that the actions identified in the 2007 fire risk assessment have been addressed.
• Implement clear procedures for managing comments, concerns or complaints. Review the complaints process and ensure that patients receive written confirmation of investigation and actions taken and that learning is identified to improve the service.