Lyneham Dental Centre Inspection Report
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Defence Medical Services Lyneham Dental Centre Inspection Report Calne Road Lyneham Chippenham Wiltshire Date of inspection visit: 27/02/2018 SN15 4PZ Date of publication: 20/04/2018 Overall summary We carried out an announced comprehensive inspection of Lyneham Dental Centre on 27 February 2018. To get to the heart of patient’s experience of care and treatment we asked 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 formed the framework for the areas we looked at during the inspection. Our findings were: Are services safe? No action required Are services effective? No action required Are services caring? No action required Are services responsive? No action required Are services well-led? No action required Lyneham Dental Centre Inspection Report 27/02/2018 1 Why we carried out this inspection The Care Quality Commission (CQC) carried out this inspection as one of a programme of inspections at the invitation of the Surgeon General in his role as the Defence Authority for healthcare and medical operational capability. Defence Medical Services (DMS) are not required to register with CQC under the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. Consequently DMS services are not subject to inspection by CQC and CQC has no powers of enforcement. However, where CQC finds shortfalls in the quality of services during inspection, we will report them by making a recommendation for action to the Surgeon General’s office. This inspection was led by a CQC inspector and supported by a dental specialist advisor. Background to this practice Lyneham Dental Centre is located on MOD Lyneham military base, at Lyneham, Wiltshire. The dental centre is co-located with the medical centre in a purpose built facility, opened in November 2015. The facility has five fully equipped surgeries and a central cleaning, decontamination and sterilisation unit. The practice has two full time dental officers, one dental hygienist, one dental therapist, six dental nurses, a receptionist and a practice manager. The population served by the dental centre is made up of approximately 2,500 patients. MOD Lyneham is a phase two and three training site for military personnel which means the practice population figure can fluctuate. There are also a number of reservists who receive dental services from the practice. The length of courses provided at the training facility can range from six months to 18 months. Where a patient is to be based at the training centre for more than five months, they are required to register with the dental centre. The staff at the dental centre provide general dentistry, dental therapy, dental hygiene, oral education sessions, minor oral surgery, secondary care referrals and specialist referrals, for example, to the Centre for Restorative Dentistry, which is a military facility based in Aldershot, Hampshire. The dental centre is open Monday to Wednesday, from 0745 hours to 1230 hours, then from 1330 hours to 1700 hours. On Thursday the centre is open from 0745 hours to 1230 hours and from 1330 hours to 1630 hours. On Friday the centre is open from 0745 hours to 1245 hours. An emergency service is provided outside of these hours on a rotational basis, details of which are available from the guard room on site. How we carried out this inspection The inspection team visiting the dental centre was led by a CQC Lead Inspector, and included a dental nurse specialist advisor and a senior dental officer specialist advisor. On the day of inspection we collected 43 CQC comment cards filled in by patients and spoke with one other patient. This information gave us a positive view of the practice. During the inspection we spoke with two dentists, two dental nurses, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed. Our key findings were: Lyneham Dental Centre Inspection Report 27/02/2018 2 • The practice was clean and well maintained. • The practice had infection control procedures in place which reflected published guidance. • Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. • The practice had systems to help them manage risk. • The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. • The practice had staff recruitment procedures in place, including for locum staff. • 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. • The appointment system met patients’ needs. • The practice had effective leadership. Staff felt involved and worked well as a team. • The practice asked staff and patients for feedback about the services they provided. • The practice dealt with any complaints positively and efficiently. • Staff demonstrated their understanding of the Duty of Candour and gave examples of how they met the requirements of this. We found areas where the practice could make improvements. CQC recommends that the practice: • Ensure the safe management of medicines, including controlled medicines. • Review governance processes for example, record keeping in respect of daily equipment checks, infection control spot checks and PAT testing. • Review staff training to ensure that clinicians carry out collaboratively, an assessment of the needs and preferences for care and treatment in line with the provisions of the Mental Capacity Act 2005 and Gillick competence. Dr John Milne MBE BChD, Senior National Dental Advisor (on behalf of CQC’s Chief Inspector of Primary Medical Services) Lyneham Dental Centre Inspection Report 27/02/2018 3 Detailed findings Are services safe? Our findings We found that this practice was safe in accordance with CQC's inspection framework The shortcomings did not have a significant impact on the safety and quality of clinical care. Reporting, learning and improvement from incidents The Automated Significant Event Reporting (ASER) DMS-wide system was used to report, investigate and learn from significant events, incidents and near misses. Staff were clear in their understanding of the types of significant events that should be reported and understood how to report an incident, including when to report in accordance with the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). From a log of significant events kept by the practice, we could see that three incidents had been reported in the past 12 months. When we made checks we found that one staff member did not have a log-in for the system, and was reliant on the practice manager to make any reports on their behalf. We were told that any incidents were discussed at practice meetings, and findings shared between staff to ensure learning from incidents. When we checked minutes of practice meetings, we saw that significant events were a standing agenda item, but those that had happened recently and had been investigated, were not recorded as having been discussed. The practice manager and Senior Dental Officer received alerts via Regional Headquarters, from the Medicines and Healthcare Products Regulatory Agency and from the Department of Health Central Alerting System. Those that were relevant to dental practice were circulated to all staff. We could see from minutes of meetings that these alerts were a standard agenda item for discussion. We were told that any alerts received that were relevant would be discussed at practice meetings or at team meetings before the start of morning clinics. Reliable safety systems and processes (including safeguarding) A GP from the medical facility co-located with the dental centre, was the lead for all safeguarding matters. A second GP acted as a deputy. Both were trained to level three safeguarding children and adults. The staff team in the dental centre had all completed training at a level appropriate to their role. Training was refreshed every three years. Staff we spoke with were aware of their responsibilities if they had concerns about the safety of young people and adults who were vulnerable due to their circumstances. A safeguarding policy and procedure was in place to provide staff with information about identifying, reporting and dealing with suspected abuse. Lyneham Dental Centre Inspection Report 27/02/2018 4 The practice had not had to manage a safeguarding concern. Staff highlighted that there was a potential for patients aged 16 to 18 to be treated at the practice. Staff were able to give examples of safeguarding concerns in relation to patients in this age group, and how they would report these concerns. The dentists and the dental therapist were always supported by a dental nurse when providing treatment. The hygienist did not have the support of a nurse when treating patients. A risk assessment was in place to support this working practice and there was an alarm in the treatment rooms to summon assistance in the event of a medical emergency. All treatment rooms had an emergency alarm in place. We looked at the practice’s arrangements for safe dental care and treatment. These included risk assessments that were regularly reviewed. The practice followed relevant safety laws when using needles and other sharp dental items. The dentist routinely used rubber dams when providing root canal treatment in line with guidance from the British Endodontic Society. A whistleblowing policy was in place and available to staff. Staff accurately described what they would do if they wished to report in accordance with the policy. They said they felt confident they could raise concerns and would be supported to do so. A business continuity plan was in place, which set out how the service would be provided if an incident occurred that impacted on its operation.