Updated 20 August 2018
We carried out this announced inspection on 19 July 2018 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.
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
Marjory Lees Dental Centre is in Oldham and provides NHS and private treatment to adults and children.
There is level access for people who use wheelchairs and those with pushchairs. The practice has a car park, which includes spaces for blue badge holders.
The dental team includes six dentists (three partners and three associate dentists), nine dental nurses, and two receptionists. The practice has six treatment rooms.
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 Marjory Lees Dental Centre was the senior partner.
On the day of inspection, we collected 44 CQC comment cards filled in by patients, with a further seven completed by staff and one completed by a service engineer.
During the inspection we spoke with four dentists, four dental nurses and a receptionist. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open:
Monday to Thursday 8.30am to 12.30pm and 1.30pm to 5pm
Friday 8.30am to 12.30pm
Our key findings were:
- The practice appeared clean and well maintained.
- The practice staff had infection control procedures which reflected published guidance.
- Staff knew how to deal with emergencies. Minor improvements were needed to the life-saving equipment available.
- The practice had systems to help them identify and manage risk.
- The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
- The practice had thorough staff recruitment procedures.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- The practice was providing preventive care and supporting patients to ensure better oral health.
- The appointment system met patients’ needs.
- The practice had effective leadership and culture of continuous improvement.
- Staff felt involved and supported and worked well as a team.
- The practice asked staff and patients for feedback about the services they provided.
- The practice staff dealt with complaints positively and efficiently.
- The practice staff had suitable information governance arrangements.
There were areas where the provider could make improvements. They should:
- Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to documenting decisions, preventing further occurrences and ensuring that improvements are made as a result.