Updated 22 February 2023
We carried out this announced comprehensive inspection on 27 January 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 practice was undergoing extensive renovations and building works at the time of our inspection to include additional treatment rooms, dedicated decontamination rooms, additional storage areas, staff and training rooms. The dental clinic appeared clean and well-maintained.
- The practice had infection control procedures which mostly reflected published guidance.
- Staff knew how to deal with medical emergencies. Most appropriate medicines and life-saving equipment were available. Those items that were identified by us as missing were obtained following the inspection.
- Protocols for the disposal of medicines and security of prescriptions were not in place. The practice took immediate action to improve systems following the inspection.
- Not all staff supporting sedation had undergone the required training. Following the inspection the practice confirmed this would be reviewed.
- The consent policy did not include information about the Mental Capacity Act 2005 or make reference to Gillick competence. Not all staff understood their responsibilities under the acts.
- Safeguarding processes were in place and staff knew their responsibilities for safeguarding vulnerable adults and children.
- The practice had staff recruitment procedures which reflected current legislation.
- Clinical staff provided patients’ care and treatment in line with current guidelines.
- 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 appointment system worked efficiently to respond to patients’ needs.
- The frequency of appointments was agreed between the dentist and the patient, giving due regard to National Institute of Health and Care Excellence (NICE) guidelines.
- The provider had effective leadership and was implementing a culture of continuous improvement. At the time of our visit, areas such as legionella risk assessment, fire yearly electrical fixed wire testing had not been completed due to the provider prioritising facility improvements and renovations. The practice confirmed that these had been scheduled following the completion of the building work.
- 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.
Background
Hatfield Peverel Dental Surgery is in Hatfield Peverel, Chelmsford, Essex and provides NHS and private dental care and treatment for adults and children. In addition to general dentistry, the practice provides a sedation service, Cone-beam computed tomography systems (CBCT) X-rays and is a dental foundation training practice for dentists. The practice also provides a dental implant service from a visiting dental specialist.
There is step free access to the practice for people who use wheelchairs and those with pushchairs as well as a large accessible toilet. Car parking spaces, including dedicated parking for disabled people, are available outside the practice and in local free car parks. The practice is in the process of expanding the building and making many adjustments to support patients with additional needs. These will include additional ground floor and first floor treatment rooms, a new decontamination room, storage and training rooms.
The dental team includes 4 dentists, 6 dental nurses including 1 trainee dental nurse, 7 dental hygienists, 1 receptionist and 1 practice manager. The practice has 5 treatment rooms.
During the inspection we spoke with 2 dentists, 2 dental nurses, 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 to Thursday from 8am to 5.30pm.
Friday from 8am to 2pm.
We noted innovative approaches to providing person centred care. The practice had introduced children days during school holidays. These were specific drop-in days for children and families who were not registered with an NHS dentist. The practice team including NHS dentists, hygienists and dental nurses were on hand to encourage families with young children to attend for NHS oral health advice and preventative care. Goody bags with oral health products were provided for children who attended. In addition, the practice issued a quarterly practice newsletter providing the latest updates about the practice services, the practice team and the latest oral health news.
The practice had taken steps to improve environmental sustainability. The practice encouraged recycling; patients returned empty toothpaste tubes to reduce the use of plastic. Where the practice shredded documents they used a system of universal shredding, the results of this were then used for animal bedding. In addition, the practice had included the fitting of led box ceiling lights (LED) in treatment rooms and motion sensor LED lights on stairs for hands free illumination and to reduce the use of electricity.
There were areas where the provider could make improvements. They should:
- Take action to ensure that dental nursing staff who assist in conscious sedation have the appropriate training and skills to carry out the role, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015'.
- Improve the practice's protocols for medicines management and ensure all medicines are stored and disposed of safely and securely. In addition, improve the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
- Take action to ensure the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
- Improve and develop the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.