Hilsea Dental Care

We carried out an announced comprehensive inspection on 20 September 2016 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 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

Hilsea Dental Care provides both private and NHS treatment to patients of all ages. The practice is part of the corporate provider brand Southern Dental Limited. The practice is based in a converted domestic dwelling in Portsmouth, south Hampshire.

The practice has three dental treatment rooms of which all are based on the ground floor and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The ground floor is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs three dentists, two hygienists, two dental nurses, two receptionists and a practice manager who is also a registered dental nurse.

The practice’s opening hours are Monday between 8am and 8pm, Tuesday and Friday between 9am and 5pm, Wednesday and Thursday between 9am and 8pm and Saturday between 9am and 1pm.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

There was no registered manager at the time of our inspection at this location. We were told that the current Practice Manager was registered with CQC at another location nearby and was going through the CQC registration process to become the registered manager of both locations.

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.

We obtained the views of five patients on the day of our inspection.

Our key findings were:

• Leadership was provided by a newly appointed enthusiastic and hardworking practice manager.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The internal aspects of the practice appeared clean and maintained. We did note issues with some aspects of the outside of the practice.
• There appeared to be sufficient equipment for staff to undertake their duties, and equipment was well maintained. Although improvements could be made to the efficient storage arrangements for dental instruments.
• Infection control procedures generally followed published guidance although there were areas that could be improved. This included protocols around manual cleaning, recording of validation cycles of the automated washer disinfector and the storage of environmental cleaning equipment.
• The practice had effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• Staff received training appropriate to their roles and were supported in their continued professional development (CPD) by the company.
• Staff we spoke with felt well supported by the practice manager and were committed to providing a quality service to their patients.
• We were told of issues with the company head office responding in a timely way to issues raised by the staff. This included shortages of staff and instruments and because of this staff were not always happy in their work.
• Information from five completed Care Quality Commission (CQC) comment cards gave us a mostly positive picture of a friendly, caring, professional practice.

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

• Review the availability of a hearing loop for patients who wear hearing aids.
• Consider providing the hygienist with the support of an appropriately trained member of the dental team.
• Review the contents of the annual infection control statement in relation to infection prevention control required under The Health and Social Care Act 2008: Code of Practice about the prevention and control of infections.
• Review the storage of processed instruments to make the process of identifying the numbers of instruments required for each clinical session more efficient. Specifically, the practice could consider placing examination packs in one storage box, filling instrument packs in another, dental hand pieces in another and so on.
• Consider discontinuing using the present staff toilet and reverting to using the patient toilet for both staff and patients.
• Consider the provision of a non-foot operated waste bin and mirror for disabled patients in the patient toilet.
• Review the protocols with respect to the manual scrubbing of instruments and the subsequent loading of instruments in the ultrasonic cleaning bath.
• Review the availability of a thermometer for ensuring that the temperature of the water used for manual scrubbing is below the recommended temperature of 45 degrees for this procedure.
• Review the training of nurses in respect of recording the daily validation cycles of the automated washer disinfector.
• Review the safety arrangements of the window blinds in the practice; this should include carrying out a suitable risk assessment of the pull cords.
• Review the checking procedures of the emergency lighting system.
• Review the cleanliness of the external environment of the practice, including the use of the neighbour’s domestic waste bin at the front of the practice and the removal of animal excrement from the back garden area.
• Consider the provision of an external name plate providing details of the dentists working at the practice including their General Dental Council (GDC) registration number in accordance with GDC guidance March 2012.
• Review the recording of the details of the subjects discussed during the staff meetings to capture the standing items which are part of the practice’s policy.