Ash Tree House Dental Surgery

We carried out this announced comprehensive inspection on 22 May 2023 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 practice 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 advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following 5 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:

• The dental clinic appeared clean and well-maintained.
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff knew how to deal with medical emergencies, but improvement was needed to ensure emergency medicines and equipment were appropriate.
• The practice had staff recruitment procedures which reflected current legislation.
• Clinical staff provided patients’ care and treatment in line with current guidelines.
• Improvements were needed to infection control procedures to ensure they reflected published guidance.
• Patients were treated with dignity and respect. Staff took care to protect patients’ privacy and personal information.
• Staff provided preventive care and supported patients to ensure better oral health.
• The practice had systems to manage risks for patients, staff, equipment and the premises but improvements were needed to ensure processes were effective.
• The appointment system worked efficiently to respond to patients’ needs.
• Staff felt involved, supported and worked as a team.
• Staff and patients were asked for feedback about the services provided.
• Complaints were dealt with positively and efficiently.
• The practice had information governance arrangements.
• The practice had quality assurance processes to encourage learning and continuous improvement, but these were not operated effectively.

Background

Ash Tree House Dental Surgery is in Wooburn Green and provides NHS and private dental care and treatment for adults and children.

There is step free access to the practice, via a ramp, for people who use wheelchairs and those with pushchairs. Car parking spaces, including dedicated parking for disabled people, are available outside the practice. The practice has made reasonable adjustments to support patients with access requirements.

The dental team includes 6 dentists, 1 implant specialist, 2 qualified dental nurses, 3 student dental nurses, 3 dental hygienists, 1 practice manager and treatment coordinator, 1 receptionist.

The practice has 4 treatment rooms.

During the inspection we spoke with 3 dentists, 2 dental nurses, 1 student dental nurse, 1 dental hygienist, 1 receptionist and the practice manager.

We looked at practice policies, procedures and other records to assess how the service is managed.

The practice is open:

• Monday 8.30am to 6.00pm
• Tuesday 8.30am to 5.00pm
• Wednesday 8.30am to 6.00pm
• Thursday 8.30am to 6.00pm
• Friday 8.30am to 3.00pm
• Saturday 9.00am to 2.00pm (alternate weeks)

We identified regulations the provider was not complying with.

They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There were areas where the provider could make improvements.

They should:

• Take action to ensure that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Take action to ensure the clinicians take into account the guidance provided by the College of General Dentistry when completing dental care records.
• Improve the practice protocols regarding auditing patient dental care records to check that necessary information is recorded.
• Take action to ensure an automated external defibrillator (AED) is available immediately to manage medical emergencies, taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council, and undertake a risk assessment if a decision is made not to have an AED on site.
• Implement audits for prescribing of antibiotic medicines taking into account the guidance provided by the College of General Dentistry.

The provider accepted the shortfalls that we raised and took immediate action the day of our inspection to begin to address these.