We carried out an announced comprehensive inspection on 08 September 2015 to ask the service 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

The Glastonbury dental access centre is situated in the centre of Glastonbury town. The centre has three dental treatment rooms, a decontamination room for the cleaning, sterilising and packing of dental instruments and a reception and waiting area. Services are provided on two floors. The main entrance to the centre is accessible by external steps with an electric stair lift for wheelchair patients although this does have a weight limitation. The centre is open Monday to Friday 8.30am – 12.30pm & 1.30pm - 5.00pm.

Glastonbury Dental Access Centre has two dentists and two dental nurses and a part time Dental Therapist. The centre manager and clinical team are supported by one receptionist. Satellite services are provided at Frome but this was not inspected. The access centre is also supported by an Oral Health Promotion team operating from the Burnham-on-Sea satellite clinic.

The service provides NHS oral healthcare and dental treatment for children and adults that have an impairment, disability and/or complex medical condition. People who come into this category are those with a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability, including those who are housebound.

A sedation service is provided where treatment under a local anaesthetic alone is not feasible and conscious sedation is required. The service provides an ‘in-hours’ emergency dental service for those patients who do not have a regular dentist. The service also provides a domiciliary service for those patients unable to access the Glastonbury Dental Access Centre.

Before the inspection we sent Care Quality Commission comment cards to the centre for patients to complete to tell us about their experience of the centre but none had been completed. During the inspection we spoke with seven patients, parents and carer’s five staff and the centre manager who is the senior dental nurse. The patients we spoke with were very complimentary about the service. They told us they found the centre and staff provided excellent and highly professional care; were extremely friendly and welcoming and all patients felt they were treated with dignity and respect.

Our key findings were:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment during their appointments.

• There were comprehensive policies and procedures identified at the centre, however we found some of these were incomplete namely the IRMER file and equipment maintenance logs. We were advised the ‘missing’ information was at the trust HQ in Bridgwater.

• We observed staff were passionate about working within the service and providing good quality care for patients. We saw evidence of service improvement initiatives and regular monitoring of the quality of the service with audits of infection control and radiographs.

• There was a strong commitment across the staff team to providing co-ordinated and responsive assessments and treatment for patients.

• Services were organised so they meet patient’s needs.

• The location had effective local clinical leadership provided by an experienced Senior Dental Officer with extensive experience in special care dentistry. Staff followed current professional guidelines in areas of special care dentistry, and conscious sedation when caring for patients.

• Staff had received training appropriate to their roles and were supported in their continuing professional development.

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available. However, emergency equipment used for domiciliary visits required review to ensure it was meeting appropriate national guidelines to ensure risks to these patients were reduced and patients kept safe if an emergency arose.

• Infection control procedures were comprehensive and the centre followed published guidance. The environment was visibly clean and well maintained and patients told us they felt the premises were clean.

• Effective safeguarding processes were in place for safeguarding vulnerable children and adults and staff fully understood the implications of the Mental Capacity Act 2005.

• The centre had good facilities including disabled access. However we noted the electric stair lift had weight limitations.

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

• Ensure the cleaning contractor conforms to published National Patient Safety Association (NPSA) regarding cleaning of dental premises.

• Rectify the 18 defects noted in the Legionella risk assessment carried out 10 December 2013.

• Ensure when carrying out domiciliary visits they take appropriate emergency equipment as advised by the British Society for Disability and Oral Health (BSDH) August 2009.
• 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 staff were recruited safely according to the Trust 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.
• Ensure all equipment is regularly serviced in line with approved guidance.

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:

• Ensure the centre manager and senior clinician are empowered to make local decisions in the best interest of Glastonbury access centre.

• The whistle blowing policy did not include information about who staff could raise concerns with externally such as the Care Quality Commission (CQC).

On the day of our visit we spoke with two patients and reviewed 16 comment cards. Patients’ comments were complimentary about the centre. All felt they were treated with respect and dignity. They told us they felt safe in the centre and were confident in the staffs knowledge and skills. We observed consent to treatment was obtained prior to treatment thus respecting patient's wishes.

We saw there had been a patient satisfaction survey undertaken in March 2014 in which 100% of patients had said they were happy with all aspects of care, treatment and service provided. We saw information about the emergency number for out of hours access was displayed in the waiting room and patients reported they were aware of it.

The centre offered conscious sedation for nervous patients or those who have a dental phobia. Conscious sedation is defined as “a drug induced state of sedation where consciousness is minimally depressed so the patient is able to independently maintain their airway, retain protective reflexes, and remain responsive to verbal commands”).

The centre had access for patients with disabilities including wheelchair users. Once in the centre they were able to access all areas of service provision.

We spoke with six members of staff who told us the centre was friendly, safe and responsive to patient's needs. They told us they felt the centre was well led by an approachable manager.

Systems were in place to ensure sufficient numbers of suitably qualified staff were available to provide the service offered.

We saw effective systems were in place to monitor and improve the quality of the service provided.