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

Background

The Yeovil Dental Access Centre (DAC) is situated near the centre of Yeovil town. The access 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 the ground floor. The main entrance to the practice is accessible for wheelchair patients. The practice is open Monday to Friday 8:30am to 12:30pm and 1:30pm to 5pm and alternate Saturday mornings. 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.

Yeovil DAC has two dentists and two dental nurses and a part time Dental Therapist. Treatment by the dental therapist is carried out following consultation with a dentist. The centre manager and clinical team are supported by one receptionist. The DAC is also supported by an oral health promotion team operating from the Burnham–on-Sea satellite access centre. The staff team offer minor oral surgery treatments, on referral, under local anaesthetic two days a week. The staff team also provide dental treatment for children and adults with learning disabilities under general anaesthetic at Yeovil District General Hospital for one session each week.

The service provides NHS oral health care and dental treatment for children and adults that 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.

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 dental service for those patients unable to access the Yeovil Dental Access Centre.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the centre. Unfortunately none had been completed. During the inspection we spoke with eight patients, parents and carer’s; 10 clinical 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 practice 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:

• The centre was effective in treatments provided, caring and responsive to patients needs and well led by the senior dental nurse.

• The practice had systems and processes in place which ensured patients were protected from abuse and avoidable harm. Staff fully understood the implications of the Mental Capacity Act 2005.
• Services were organised so they meet patients’ needs.
• Patients told us 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 practice, however we found some of these were incomplete namely the Ionising Radiation Regulations 1999 and Ionising Radiation (Medical Exposure) Regulations 2000 (IR(ME)R) 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. There was 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 assessment and treatment for patients.

• 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 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 to be kept safe if an emergency arose.

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

• Staff had received training appropriate to their roles and were supported in their continuing professional development.
• The centre had good premises and facilities including access for patients with poor mobility.

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

• Ensure the cleaning contractor conforms to published National Patient Safety Association (NPSA) guidance regarding cleaning of dental premises.
• Implement recommendations in the legionella risk assessment carried for the Trust in 2013.
• 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.

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:

• Should ensure the centre manager and senior clinician is empowered to make local decisions in the best interest of Yeovil DAC.
• The whistle blowing policy did not include information about who staff could raise concerns with externally such as the Care Quality Commission (CQC).