Updated 25 September 2017
We carried out this unannounced inspection on 5 July 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 registered provider 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 for us to take into account.
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 providing well-led care in accordance with the relevant regulations.
Background
De-ientes Bedford is located in Bedford, which is the county town of Bedfordshire. It provides NHS and private treatment to patients of all ages. The provider also has a second De-ientes practice in Clapham, Bedford. We did not inspect the Clapham practice.
There is level access for people who use wheelchairs and pushchairs as a concrete ramp has been built directly outside the building entrance. There is limited car parking at the premises, but there is a large public car park within close vicinity to the practice. The public car park has spaces for patients with disabled badges. There are also some disabled car parking spaces on the road of the practice.
The practice has four treatment rooms; three are on the ground floor.
The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission 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 De-ientes Bedford is one of the senior partners.
The practice is an approved training practice for dentists new to general dental practice. De-ientes Bedford has been a training practice since 2005. The practice currently has two trainee dentists working in the practice.
On the day of inspection we collected nine CQC comment cards filled in by patients. This information gave us a positive view of the practice.
During the inspection we spoke with three dentists, two dental nurses (who were also clinical team leaders), two trainee dental nurses, one receptionist and the reception and practice administration team leader. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open Monday to Friday from 9am to 5.30pm and Saturday from 9am to 1pm (private treatments only).
Our key findings were:
- The practice ethos included the provision of high quality dental care for their patients alongside the promotion of good oral health. The ethos also included actively involving patients about their care and encouraging them to fully participate.
- Effective leadership was evident although we found areas where management arrangements required strengthening.
- Staff had been trained to deal with medical emergencies. We found appropriate medicines were readily available in accordance with current guidelines. We found there were some items of equipment either missing or that had expired. These were subsequently ordered and replaced.
- The practice appeared clean and well maintained.
- Staff demonstrated knowledge in relation to their responsibilities for safeguarding adults and children living in vulnerable circumstances.
- The practice had staff recruitment procedures, however, these required strengthening.
- Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
- The practice demonstrated awareness of the needs of the local population and took these into account when delivering the service.
- Patients had access to treatment and urgent and emergency care when required.
- The appointment system met patients’ needs.
- The practice dealt with complaints positively and efficiently.
- Staff had received most training appropriate to their roles. Staff were supported in their continued professional development (CPD) by the practice.
- Dental nurses, trainee dental nurses and reception and administrative staff we spoke with, felt supported by the provider and were committed to providing a quality service to their patients.
There were areas where the provider could make improvements. They should:
- Review practice's recruitment procedures to ensure that appropriate background checks are completed prior to new staff commencing employment at the practice. Risk assessments should be undertaken for staff whose DBS or hepatitis B immunity status checks have not been completed.
- Regularly monitor and record water temperatures as part of the legionella risk assessment taking into account guidelines issued by the Department of Health – Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
- Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
- Review the practice's process for undertaking audits and ensure all identified objectives and recommendations are reviewed during the next audit cycle.