Smith, Holloman, Malapati & Associates

We carried out this announced comprehensive inspection on 5 January 2024 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.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with medical emergencies. Not all life-saving equipment were available. Systems for checking emergency equipment and medicines required strengthening.
• Some systems to manage risks for patients, staff, equipment, and the premises needed improvement. Policies needed reviewing and updating and Control of Substances Hazardous to Health substances were missing individual risk assessments.
• 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 audit process needed development to ensure a culture of continuous improvement.
• 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

Smith, Holloman, Malapati and Associates is in Bromyard, Herefordshire and provides NHS and private dental care and treatment for adults and children. In addition to general dentistry, they also carry out implant and orthodontic treatments. The services are provided by three individually Care Quality Commission registered providers at this location. This report only relates to the provision of private dental care provided by Smith, Holloman, Malapati and Associates. The additional reports are available in respect of the other NHS services which are registered under Holloman, Malapati and Associates and David Holloman Dentistry - High Street Bromyard.

Due to building limitations, the provider was unable to provide step free access to the practice or dedicated parking spaces for patients with disabilities. The practice has made reasonable adjustments to support patients with access requirements such as a ground floor treatment room.

The dental team includes 2 dentists, 6 dental nurses (including 3 trainee nurses), 1 dental hygienist, 1 dental therapist, 1 practice manager, 1 administrator and 3 receptionists. The practice has 4 treatment rooms.

During the inspection we spoke with 2 dentists, 3 dental nurses, 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 from 9am to 8pm

Tuesday from 9am to 5.30pm

Wednesday from 9am to 5.30pm

Thursday from 9am to 5.30pm

Friday from 9am to 4pm

There were areas where the provider could make improvements. They should:

• Implement an effective system of checks of medical emergency equipment and medicines taking into account the guidelines issued by the Resuscitation Council (UK).
• Improve the practice's processes for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.
• Take action to ensure audits of record keeping are undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, audits have documented learning points, and the resulting improvements can be demonstrated.

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