We carried out this announced inspection on 7 November 2017 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 principal dentist 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.
We told the NHS England area team that we were inspecting the practice. They did not provide any information.
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 not providing well-led care in accordance with the relevant regulations.
Background
Hillcrest Dental Surgery is in Wolverhampton and provides mainly orthodontic NHS and private treatment to patients of all ages.
There is a small step to gain access to the premises; the practice does not have a portable ramp for people who use wheelchairs and pushchairs. The practice does not have a car park but parking is available in local side roads.
The dental team includes one dentist (the principal dentist), two dental nurses, and one receptionist. The practice has two treatment rooms, only one of which is in use.
The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.
On the day of inspection we collected 46 CQC comment cards filled in by patients. This information gave us a positive view of the practice.
During the inspection we spoke with the principal dentist, one dental nurse, and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open: Monday 9am to 4pm and Tuesday to Thursday 9am to 5.30pm. The practice is closed for one hour each lunchtime.
Our key findings were:
- The practice was clean and patients commented that this was always the case. There had been some damage to the windows of the practice (which were boarded up) due to a recent burglary.
- Evidence was not available to demonstrate that all equipment was serviced or maintained in accordance with manufactures instructions.
- The practice had infection control procedures which reflected published guidance.
- Staff knew how to deal with emergencies. Not all of the required life-saving equipment was available.
- The practice had some systems in place to help them manage risk although some risk assessments were overdue for review.
- The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- The practice had a detailed staff recruitment policy but recruitment files did not demonstrate that the practice adhered to this policy on all occasions.
- The clinical staff provided patients’ care and treatment in line with current guidelines, although the dentist was not grading or justifying the need to take X-rays in patient dental care records.
- Staff appeared to have a good relationship with patients and staff were seen to speak with patients in a respectful manner. The door to the treatment room was left open when the dentist was with a patient and the computer on the reception desk was left on when the reception desk was not staffed.
- The appointment system met patients’ needs.
- Staff felt involved and supported and worked well as a team.
- The practice asked patients for feedback about the services they provided.
- We were told that the practice had not received any formal written complaints. Verbal complaints were dealt with as soon as they were received and details of these concerns were recorded on patient’s dental care records.
We identified regulations the provider was not meeting. They must:
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Full details of the regulations the provider was not meeting are at the end of this report.
There were areas where the provider could make improvements. They should:
- Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
- Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the radiograph, the reporting and quality of the radiograph ensuring the practice is in compliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
- Review staff awareness of guidelines relating to competency principles when treating any child aged under 16 years and ensure all staff are aware of their responsibilities.
- Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.