Site visits: primary care dental services

Site visits give us an opportunity to talk to people using your services, your staff and other professionals, to find out about their experiences.

They allow us to review how you deliver care and to see how people’s needs are identified and managed, both within and between services. Site visits can be announced or unannounced.

Two weeks before the site visit

For announced on-site assessments, the lead inspector will send an email to announce the date of the visit. This will tell you about the scope of the on-site visit and what to expect. We will also ask you some pre-assessment information. The inspector will also telephone the practice and the registered person to introduce themselves, make any necessary logistical arrangements and to make sure that you are prepared for the visit. The telephone conversation will include questions to assess your management systems, processes and practices. This will be part of the overall assessment process.

We won’t notify you before we carry out an unannounced on-site assessment of your service.

The start of the visit

At the start of each inspection the inspector will meet with your registered manager. If the registered manager is not available the inspector can meet with another senior member of staff, for example a partner or a practice manager. This short introductory session will introduce the inspection team and explain:

• the scope and purpose of the visit, including CQC’s powers
• the plan for the day
• how we will escalate any concerns that we identify during the visit
• how we will communicate our findings

We will ask you to present to the inspection team your own view of your practice’s performance, particularly in relation to the five key questions and to include any examples of notable practice. There is no specified format or media for this briefing – you can choose whichever format suits you best. This should take no longer than 20 minutes.

We want you to be open and share your views with us about where you are providing care that you are proud of, and what you are doing to improve in areas that you have identified need particular attention.

The inspection team will review the emerging findings together at least once during the inspection. This keeps the team up-to-date with all issues and allows them to shift the focus of the inspection if they identify new areas of interest. It also enables the team to identify which further evidence they might need in relation to a line of enquiry and what relevant facts they might still need to support a judgement.

Gathering evidence during the site visit

To structure the site visit, the inspection team refers to the key lines of enquiry (KLOEs) in the assessment framework for healthcare services. They also look at any concerns identified beforehand through our monitoring activity. This enables them to focus on specific areas of concern or potential areas of notable practice. They collect evidence against the KLOEs using a variety of methods.

People who use services

We will gather the views of your patients, their family and carers, by:

• speaking with them individually where possible
• using information from compliments, complaints and concerns sent through our website.

Your staff

On all site visits, we are likely to speak to the following members of staff:

• practice manager
• registered manager
• receptionists
• dental care professionals, including individual dentists
• dental nurses
• visiting clinicians, where possible.

For larger providers, the inspection team may also hold focus groups with separate groups of staff.

Gathering information in other ways

We may also gather information by:

• reviewing parts of dental records to support our findings
• reviewing operational policies and supporting documents
• observing processes such as decontamination
• looking at the premises and facilities.

We may review some, or all of the following documents, for example:

• equipment maintenance certificates
• radiation protection files
• a selection of audits and action plans
• infection control policies, procedures and records
• staff recruitment policies, procedures and staff files
• staff training records
• patient satisfaction survey and findings
• records of accidents and significant events
• complaints log
• risk assessments.

(this is not a full list, as we may look at other areas).

Feedback on the visit

At the end of the site visit, the lead inspector will provide feedback. This will be high level initial feedback only, illustrated with some examples.

At the meeting, the inspector will:

• thank you for your support and contribution and tell you about any issues that were escalated during the visit or that require immediate action
• tell you if we need additional evidence or if we need to seek further specialist advice in order to make a judgement
• tell you about any plans for follow-up or additional visits (unless they are unannounced)
• explain how we will make judgements against the regulations
• explain the next steps, including how we process the draft inspection report
• answer any questions from the practice

We will need to carry out further analysis of the evidence as well as undertake several internal quality assurance processes before we can reach final judgements on all the issues.