18 November 2019
During a routine inspection
We carried out this announced inspection on 18 November 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?
These questions form the framework for the areas we look at during the inspection.
Our findings were:
Are services safe?
We found that this practice was providing safe care in accordance with the relevant regulations.
Are services effective?
We found that this practice was providing effective care in accordance with the relevant regulations.
Are services caring?
We found that this practice was providing caring services in accordance with the relevant regulations.
Are services responsive?
We found that this practice was providing responsive care in accordance with the relevant regulations.
Are services well-led?
We found that this practice was providing well-led care in accordance with the relevant regulations.
Background
Cromer Road Dental Care is in Balsall Heath, Birmingham and provides NHS dental treatment to adults and children.
There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available on local side roads near the practice.
The dental team includes four dentists, three dental nurses, three dental nurse apprentices, a manager (who is a dentist) an apprentice manager and a cleaner. The practice has four treatment rooms, only three of which are currently in use.
The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered
On the day of inspection, we collected six CQC comment cards filled in by patients. The practice was only seeing patients with a dental emergency on the day of inspection and had no booked appointments.
During the inspection we spoke with one dentist, the manager, apprentice manager and two dental nurses. The practice owner was also present during part of the inspection. We looked at practice policies and procedures and other records about how the service is managed.
The practice is open: Monday to Friday 9am to 5pm.
Our key findings were:
- The practice appeared clean and well maintained.
- The provider had infection control procedures which reflected published guidance.
- Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available but missing items were ordered on the day of inspection.
- The provider had systems to help them manage risk to patients and staff.
- The provider had mostly suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Not all staff had completed the required level of safeguarding training.
- The provider had staff recruitment procedures although these had not been followed consistently.
- The clinical staff provided patients’ care and treatment in line with current guidelines.
- Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
- Staff provided preventive care and supported patients to ensure better oral health.
- The appointment system took account of patients’ needs.
- Staff felt involved and supported and worked well as a team.
- The provider asked staff and patients for feedback about the services they provided.
- The provider dealt with complaints positively and efficiently.
There were areas where the provider could make improvements. They should:
Take action to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.
Implement an effective recruitment procedure to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
Take action to ensure that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
Take action to ensure the regulated activities at Cromer Road dental practice are managed by an individual who is registered as a manager.