We carried out an announced comprehensive inspection on 8 September 2015 as part of our planned inspection of community dental practice locations in Somerset Partnership NHS Foundation Trust (SOMPAR). The inspection took place over one day by a CQC dental specialist adviser and the CQC lead inspector. We asked the centre the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found this centre was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found this centre was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this centre was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this centre was not providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this centre was not providing well-led care in accordance with the relevant regulations.

Background

Bridgwater dental access centre provides a dental service for all age groups who require a specialised approach to their dental care and who are unable to receive this in a general dental practice.

The service provides oral health care and dental treatment for children and adults who have an impairment, disability and/or complex medical condition. People who come in to this category are those with a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability, including those who are housebound or live in a nursing or residential home.

The centre has three treatment rooms, there were two dedicated decontamination rooms (one room for cleaning instruments and the other room for sterilising them) and a dedicated orthopantomogram X-ray (provides a view of all teeth and supporting structures) room including digital X-rays within all treatment rooms. The practice is purpose built all treatment rooms are on the ground floor, which are fully accessible for patients with poor mobility. The premises also include an accessible toilet and a waiting area. Patients are greeted by reception staff at the entrance of the centre.

The staff structure covering the Somerset dental access centres comprises of dentists with a specialist interest in oral surgery, general dentists, dental nurses, dental hygienists and dental therapists. There was also a reception administration team comprising of two receptionists per shift.

The centre is open from 8:30am until 12:30pm and 1:30pm until 5.00pm Monday to Friday. Appointments are generally by referral only, although in exceptional circumstances patients can be seen regularly for general dentistry, so there are a small proportion of appointments available for urgent and routine dentistry treatment that would normally be received in a general dental practice.

Additional services provided are an inhalation sedation service where treatment under a local anaesthetic alone is not feasible and conscious sedation is required, domiciliary dental services where dental staff will visit patients in their own home or from within a nursing and residential environment and minor oral surgery is performed here. Somerset Dental Advice Line is based within the premises and provides advice to people within the Somerset area of where they can access dental treatment.

Bridgwater dental access centre has two satellite services based in Burnham on Sea and Minehead. At the Burnham-on-Sea branch they normally open on a Friday for special care dentistry and domiciliary dental services. The Oral Health Team are based at Burnham-on-Sea. At the Minehead branch they normally open two days a week providing special care dentistry and inhalation sedation. The services at Burnham-on-Sea and Minehead have both been temporarily suspended due to staff vacancies. Somerset Partnership Trust are recruiting for both dentist and dental therapist vacancies and once recruitment is complete they will be re-opening again. Bridgwater and Taunton Dental access centres are providing cover for appointments and domiciliary services.

This is the first inspection Bridgwater Dental Access Centre has received since registration in 2011.

We spoke with three patients during the inspection who provided feedback about the service and we received 10 Care Quality Commission comment cards from patients. Patients told us dental staff were kind, compassionate and understanding of their needs. Patients were given time to understand their treatment options and what to expect when visiting for treatments. Patients had confidence in all staff and were respected and treated as individuals.

Our key findings were:

• The centre had systems and processes in place which ensured patients were protected from abuse and avoidable harm.
• Patients’ care, treatment and support achieved good outcomes, promoted a good quality of life and was based on the best available evidence.
• Staff involved, and treated, patients with compassion, kindness, dignity and respect.
• Services were organised so they met patients’ needs.
• The leadership, management and governance of the organisation assured the delivery of high-quality; patient centred treatment and care, supported learning and innovation, and promoted an open and fair culture.
• Systems and processes required improvement for infection control, fire safety and equipment for dealing with emergencies when carrying out domiciliary treatment.
• Patients were kept waiting longer than the standard met when referred to the centre. However, there was a system in place to ensure patients with higher need were seen as a priority.

We identified regulations that were not being met and the provider must:

• Have in place records of what is expected of cleaners and records of schedules completed by the cleaners.
• Complete recommended actions following the legionella risk assessment to reduce risk to patients and staff using the access centre.
• Ensure immunisation status is recorded for all staff who have received hepatitis B immunisation as directed by the Code of Practice on the prevention and control of infections, appendix D criterion 9(f).
• Ensure they take all the required emergency kit with them when undertaking domiciliary visits.
• Ensure patients are not kept waiting longer than the standard wait time for referrals.
• Ensure staff were recruited safely according to the Trusts recruitment policy and Schedule 3 of the Health and Social Care Act 2008. Particularly ensuring references and gaps in employment were evidenced during the recruitment process.

For full details of the regulations not being met please refer to the Somerset Partnership NHS Foundation Trust report dated 7-11 September 2015 – Community and Specialist Dental Services in order to see the areas for which requirement notices were issued.

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

• The whistle blowing policy did not include information about who staff could raise concerns with externally such as the Care Quality Commission (CQC).
• Have in place all oropharyngeal airways including size 0.
• Review the effectiveness of the system to ensure accurate records of annual servicing of compressors for all sites are maintained and available to the centre manager .
• Individualise patient feedback to enable a clear view of patient satisfaction at individual access centres.
• Review whether training in learning disabilities is relevant and necessary due to high number of patients with a learning disability attending the practice.