Mr Andrew David Morgan - Maidenhead

Updated 5 April 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

We carried out a comprehensive inspection on 14 March 2017. The inspection was led by a CQC inspector and a specialist advisor.

We informed the local NHS area team that we were inspecting the practice; we did not receive any information of concern. We also obtained advanced information from the practice which we reviewed prior to the inspection

The methods that were used for this review included talking to people using the service, their relatives / friends, interviewing staff, observations and review of documents. During our inspection we reviewed policy documents and spoke with nine members of staff (Two dentists, three dental nurses one receptionists, area manager, operations manager and clinical director/registered provider). We conducted a tour of the practice and looked at the storage arrangements for emergency medicines and equipment. A dental nurse demonstrated how they carried out decontamination procedures of dental instruments. The practice is part of a larger corporate group.

Thirty four patients provided feedback about the service. We also looked at written comments about the practice on the practice website, comments left about patient experiences on NHS choices and the results of the published NHS Friends and Family test. Patients were positive about the care they received from the practice. They were complimentary about the friendly, professional and caring attitude of the dental staff. Patients commented that they were likely to recommend 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 5 April 2017

We carried out an announced comprehensive inspection on 14 March 2017 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 providing well led care in accordance with the relevant regulations.

Background

Mr Andrew David Morgan – Maidenhead (known locally as Damira Maidenhead) is a dental practice offering NHS and private dental treatment to adults and children, in a town center location. Maidenhead is a large town in Berkshire. The practice provides primary dental care services for people who require dental procedures. There are four dental treatment rooms two of which are situated on the ground floor and two on the first floor.

The staff structure consists of four dentists, two dental nurses, four dental nurse trainees and one practice manager. The team were supported by an area manager, operations manager and clinical director/registered provider. The practice is part of a larger corporate group.

The practice is open on Monday to Friday from 8am to 5pm. There was an answer phone message directing patients to emergency contact numbers when the practice is closed. Emergency treatment contact information was also available on the practice and NHS choices websites.

The practice partner/provider is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

The inspection took place over one day and was carried out by a CQC inspector and specialist dental advisor.

We obtained the feedback of nine patients on the day of our inspection and 25 who completed comment cards. All patients and comment cards were positive about the care they received from the practice. They were complimentary about the friendly, professional and caring attitude of the dental staff and the dental treatment they had received.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
• There were effective systems in place to reduce and minimise the risk and spread of infection.
• There was a lead staff member for safeguarding patients. All staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients indicated that they felt they were listened to and that they received good care from the practice team.
• The practice had implemented procedures for managing comments, concerns or complaints.
• Patients could access treatment and urgent and emergency care when required.
• Patients could book appointments up to 12 months in advance.
• The provider had a clear vision for the practice and staff told us they were supported by the practice managers and clinical director/provider.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Staff received training appropriate to their roles and were supported in their continued professional development by the practice managers and clinical director/provider.
• Staff we spoke to felt supported by the practice managers and clinical director/provider and were committed to providing a quality service to their patients.

There were areas where the provider could make improvements and should:

• Review the storage of dental care records to ensure they are stored securely and safely.

• Review the training, learning and development needs of staff members and have an effective process established for the on-going assessment and recording of staff training.

• Review stocks of medicines and the system for identifying and disposing of out-of-date stock.

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

• Review the practice’s audit protocols for radiography to help improve the quality of service. The practice should also check audits have been completed satisfactorily with documented learning points and that resulting improvements can be demonstrated.

• 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 infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• Review the current legionella risk assessment and implement the required actions including the application of water line treatment products, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.