We carried out an announced comprehensive inspection on 9 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

Taunton 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 into 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 was a 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 and 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 5pm Monday to Friday. Appointments are generally by referral only, although in exceptional circumstances patients can be seen regularly for general dentistry, there is 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 and intravenuous 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.

Taunton dental access centre has two satellite services based in Wellington and Chard. .At the Wellington site they normally open on a Monday and Tuesday for special care dentistry and inhalation sedation services. At the Chard site they normally open Mondays, Thursdays and Fridays providing special care dentistry and inhalation sedation. Taunton dental access centre is providing additional cover for appointments and domiciliary services to cover the suspension of two satellite services in Burnham-on-Sea and Minehead.

Taunton dental access centre had previously been inspected on 29 July 2013 and was found compliant with the relevant regulations at the time.

We spoke with one patient and one carer during the inspection who provided feedback about the service; we did not receive any Care Quality Commisson 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:

• Be carrying out fire drills and fire risk assessments at appropriate intervals according to the provider’s policy and national guidance.
• 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 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 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.
• Ensure all equipment is regularly serviced in line with approved guidance.

You can see full details of the regulations not being met at the end of this report.

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

• Should ensure the centre manager and senior clinician is empowered to make local decisions in the best interest of Taunton DAC.
• The whistle blowing policy did not include information about who staff could raise concerns with externally such as the Care Quality Commission (CQC).
• Review whether training in learning disabilities is relevant and necessary due to high number of patients with a learning disability attending the practice.

On the day of our visit we spoke with seven people who were complimentary about the practice. All felt they were treated with respect and dignity. We observed verbal, and where required written consent to treatment was obtained prior to treatment being given, thus respecting people’s wishes. All seven people told us they were informed about the treatment alternatives and possible outcomes of the treatment.

One person told us "very good service with helpful and professional staff”. Another person told us their dentist was “brilliant; didn’t rush anything and always explained treatment options well”. Two other people told us they had no concerns and found the practice to be very calm. We observed people were treated with courtesy and found that overall people felt they received an excellent service.

We saw a patient satisfaction survey and a comments book were used to gather feedback. The results demonstrated people were very happy with most aspects of the practice.

People told us they could make an appointment at times that suited them. They told us they were aware of the emergency number and had always been able to get an appointment within 24 hours.

The practice had disabled access and parking. Once in the practice the facilities were all on the ground which enabled people to access all the services offered in any surgery.

People were protected from abuse by staff who had received regular training and demonstrated good awareness of this subject.