We carried out an announced comprehensive inspection on 22 December 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

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

Are services caring?

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

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Oldbury Court Dental Centre is a dental practice providing NHS and some private dental treatment and caters for both adults and children. The practice is situated in the shopping area of Fishponds in Bristol. The practice has five dental treatment rooms, a reception and waiting area. Three of the treatment rooms are on the first floor and two on the ground floor along with other facilities enabling access for patients with limited mobility.

The practice has five dentists and five dental nurses who were supported by one receptionist and a practice manager. The practice’s opening hours are 8:30am – 5:30pm Monday to Thursday and 8:30am – 12:30pm on Fridays. For out of hours service patients are directed to ring 111.

At the previous inspection there was no registered manager. At this inspection we found a practice manager had been appointed to provide leadership in the practice and they were in the process of applying to be the Registered Manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run. However the practice did have an appointed practice manager but they were not present on the day of inspection.

We carried out an announced comprehensive inspection on 22 December 2015 to follow up on the breaches of regulation found at the last inspection on 27 October 2015. Following the last inspection we asked the provider to submit an action plan to us within 24 hours of the inspection identifying actions to address the requirement notices for the following regulations; 9 Person centred care; 10 Dignity and respect; 12 Safe care and treatment; 13 safeguarding service users from abuse and improper treatment; 17 Good governance; 18 Staffing; 19 Fit and proper persons employed. This announced inspection took place over one day and was carried out by a lead inspector with remote specialist dental advice. Following this inspection we found the service to be compliant with all relevant regulations.

We spoke with three adult patients and two children who used the service on the day of our inspection. The patients we spoke with were complimentary about the service. They told us they found the practice staff provided good care with explanations of treatment options and discussion; were friendly and welcoming and all patients felt they were treated with dignity and respect.

Our key findings were:

• The patients we spoke with indicated they felt involved in their treatment and that it was fully explained to them. Common themes were patients felt they received very good care in a clean environment from a helpful and professional practice team. We observed good communication with patients and their families; access to the service and to the dentists, was good.
• There were systems in place to help ensure the safety of staff and patients. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies.
• Appropriate recruitment processes and checks were undertaken in line with safer recruitment guidance for the protection of patients.

• Staff were supported to maintain their continuing professional development; had undertaken training appropriate to their roles and told us they felt well supported to carry out their work.

• The practice had an efficient appointment system in place to respond to patient’s needs. Patients were able to make routine and emergency appointments when required. There were clear instructions for patients regarding out of hours care.

• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.
• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.
• The practice had an accessible and visible leadership team with clear means of sharing information with staff.
• There were systems to check equipment had been serviced regularly, including the compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

We carried out an unannounced comprehensive inspection on 27 October 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

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

Are services effective?

We found this practice was not providing effective care in accordance with the relevant regulations

Are services caring?

We found this practice was not providing caring services in accordance with the relevant regulations.

Are services responsive?

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

Are services well-led?

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

Background

Oldbury Court Dental Centre is a dental practice providing NHS and some private dental treatment and caters for both adults and children. The practice is situated in the shopping area of the Fishponds in Bristol. The practice has five dental treatment rooms, a reception and waiting area. Three of the treatment rooms are on the first floor and two on the ground floor along with other facilities enabling access for patients with limited mobility.

The practice has five dentists and five dental nurses who are supported by one receptionist and a practice manager. The practice’s opening hours are 8:30am – 5:30pm Monday to Thursday and 8:30am – 12:30pm on Fridays. For out of hours service patients are directed to ring 111.

There was no  registered manager at the time of inspection to provide leadership at this location. A registered manager is a person who is registered with the Care Quality Commission to manage the service.  However it is the provider's overall responsibility to overview the service and ensure appropriate processes are put in place for the provision of regulated activities.

The provider recognised their regulatory responsibilities in relation to the Health and Social Care Act 2008 and took immediate steps to remedy the issues identified on the day of inspection. Since the inspection we have received a clear action plan with appropriate timeframes to remedy the issues identified in this report. 

We carried out an unannounced comprehensive inspection on 27 October 2015 because we had received anonymous concerns about the practice and the service it provides. The inspection took place over one day and was carried out by a lead inspector, an inspection manager and a specialist dental advisor.

We spoke with 12 patients who used the service on the day of our inspection. The patients we spoke with were complimentary about the service. They told us they found the practice and staff provided good care; were friendly and welcoming and all patients felt they were treated with dignity and respect. Two patients told us they often had to wait for their appointments and were kept informed during the period of waiting.

Our key findings were:

• The patients we spoke with indicated patients were treated with kindness and respect by staff. We observed good communication with patients and their families, access to the service and to the dentists, was good. Patients reported good access to the practice with emergency appointments available within 24 -48 hours.

• There were systems to check equipment had been serviced regularly, including the compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• The practice was not meeting the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' national guidance for infection prevention control in dental practices.

• Dental nurses working in the practice lacked understanding and practical application of the minimum requirements of HTM 01-05 and the lead person for infection control had not raised with the provider or addressed the environmental shortfalls in meeting the minimum standards.

• The management of sharps was not in accordance with the current EU regulations with respect to safer sharps (Health and Safety Sharp instruments in Healthcare Regulations 2013).

• There were no systems in place to learn and improve from incidents or healthcare alerts.

• There was no evidence of any recent audits being undertaken at the dental practice.

• Appropriate recruitment processes and checks were not undertaken in line with the relevant recruitment regulations and guidance for the protection of patients.

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

• Ensure the practice fully meets the Essential Quality Requirements of the Department of Health guidance, namely 'Health Technical Memorandum 01-05 - Decontamination in primary care dental practices (HTM 01-05)' as soon as is practically possible.
• Ensure dental sharps are managed in accordance with the current Health and Safety Sharp instruments in Healthcare Regulations 2013 and staff are appropriately trained.
• Provide training and competency assessment for staff about infection prevention and control and ensure all processes adhere to the national guidance HTM 01-05.
• Ensure appropriate systems in place to meet health and safety regulations including the reporting and management of accidents, incidents and RIDDOR reporting.
• Plan and implement a system of clinical audits as soon as practically possible for infection control, dental X-rays, clinical record keeping and other such audits as expected by the General Dental Council standards and as advised by FGDP.
• Provide clear leadership, management and governance of the practice and assess service delivery to assure the delivery of quality, patient centred treatment and care, supported by learning and innovation, and promote an open and fair culture.
• Implement a system whereby all accidents and incidents are appropriately reported and managed for the safety of patients and staff.
• Ensure records of identification checks are included in staff personnel files and use current DBS checks.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's protocols for completion of dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• There were areas where the provider could make improvements and should:

Implement current guidance (BSP) in relation to the frequency of carrying out basic periodontal examination (BPE) scoring of both children adolescents and adults and check that clinical records capture more detail about the patient assessments, treatment options and associated risk and benefits of proposed treatment.

We spoke with one person who told us they find the practice comfortable with helpful reception staff. They said the dentist always explained the treatment and gave details of different options where appropriate.

A person who had previously been with another dentist said they "Would never go back". They said they had "I had a bad experience at my previous dentist, I was worried about going to the dentist but all of the staff here have put me at my ease”". They told us they could not fault the practice. They told us that removing teeth was a last resort for the practice and "I have recommended this practice to others ".

Another person told ust the reception staff were polite. They said appointments were “on time” and that they were seen promptly.

Treatments available for people who attended the practice included examinations, fillings and root canal treatments. In addition there were cosmetic procedures including crowns, bridges, implants, clear braces and teeth whitening.

No concerns were found in respect of cross contamination or infection control. A new decontamination room had been identified but was not yet in use.

Most people told us that they knew how to make a complaint or raise a concern, one person said “I have never needed to make a complaint, If I did I would speak with the reception staff and they would point me in the right direction”.