CQC Inspection Questions Asked

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Terms discussed with CQC assessment

  • Asked for examples of practice leaflets, samples given.
  • Enquired if patient surveys are carried out, adv. we carry out in each practice annually.
  • If we provide a suggestion box,
  • How do we gain consent from patients for treatment – (Treatment plans signed in surgery)
  • How do we deal with fast track referrals?
  • How information is provided for new patients?
  • What emergency provisions do we have if a practice needs to close? – (DentaLine numbers given)
  • What training do we carry out annually? (First aid)
  • Are we mainly NHS or Private? (NHS)
  • Asked to see one card of a patient in treatment and one new patient
  • Are patients asked preferred method of pain control?
  • If we have a referral for the hygienist?
  • Do we have a protocol for postage?
  • Do we have a safeguarding vulnerable people policy for children and for adults?
  • Have Dentists/Nurses been CRB checked, including new team members – requested evidence?
  • If the reporting pathways for safeguarding are available for staff members?
  • Has all staff received training for Child Protection and Vulnerable Adults?
  • Would all staff members know how to ‘whistleblow’?
  • Is there a practice Infection Control Policy?
  • Is new staff inducted with regards to safeguarding, cross infection and date projection?
  • Are all staff members at risk of BBV exposure immunised against HEP B, including new staff members?
  • Do you have contacts or contracts with engineers, electricians, et
  • Do you comply with HTM 01-05?
  • Are audits carried out for HTM 01-05 etc.?
  • Is all staff trained in CPR?
  • Is the practise Disabled friendly?
  • IS there a dedicated Decontamination facility?
  • Is there an accident book?
  • Has a practice risk assessment been carried out?
  • How do you check your electrical items?
  • Are employment checks carried out?
  • Are all trained team members registered with the GDC and do they have insurance?
  • How are complaints dealt with?
  • Are your patients aware of your complaints procedure?
  • How are patients written and computerised records secured?
  • Requested written surveys for patients to fill in during visit.
  • Requested to talk with other staff members.
  • Requested to talk to patients at random.

QUESTIONS asked of NURSES

CQC – Things the CQC lady asked me on

  • In the decontamination room:
  • How do we use the decontamination room and step by step from clean to dirty area.
  • What we bag up before sterilising.
  • If we oil out hand-piece before or after sterilisation? – (both)
  • If we bag our instruments up at end of the day? – (as we go)
  • If we use TST strips and if these are signed by ??.
  • How often we get our autoclaves services and who does it?
  • What happens if the main autoclave breaks down – do we have a back up and is it tested on a regular basis? – Does it have a contract? – (yes)
  • Do we use our washer/disinfector? – (no)
  • Do we use aprons and heavy duty gloves? – (yes)
  • Asked about gloves, if we are able to use the latex and non-latex whenever we need to and that these are not limited in any way?
  • If we have enough stock and that this is done on a regular basis?
  • Making sure we had available PPE at all times.

In the surgery:

  • How and what we do when we see a new patient i.e. medical history, notes, radiographs etc? – (check MH, last notes, x-rays)
  • What the dentist checks with exam patient i.e. soft tissues, BPE etc.
  • What we do in-between patients with regards to cross infection. – (clean down all surfaces, chair and flush suction)
  • When and how we scrub and transfer the instruments from the surgery to the decontamination room. – (in duty box sprayed with foam)
  • If we use disposable coverings and are these changed between patients? – (yes)
  • If the dentist helps to minimise cross infection on his side?
  • Where we keep sterilised instruments? – (bagged up in drawer)
  • Do we bag them up at the end of the day? – (as we go along)
  • What do we use to run our aspirator through and when do we do this? – (start of the day)
  • How we go about writing clinical notes alongside doing clinical work. – i.e. wearing gloves while typing or do we remove them?
  • What do we use to help minimise cross infection with our computers keyboards?
  • When cleaning the aspirator, what is our routine i.e. do we clean filters etc?
  • How often do we get medical history updates?
  • Is the patient offered PPE when in for an appointment?
  • How do we dispose of amalgam waste and extracted teeth?
  • How often is this collected and who do we use?
  • How we deal with clinical waste and who collects it?
  • What we do when we have new members of staff start at the practice and what we do if a member of staff from another practice comes over to help i.e. fire drill, policies etc.

CQC Visit on 28th Feb12

  • Arrived at the practice at 09:00 and left at 12:00, one inspector.
  • She had a look at the patient notice boards in waiting area before informing staff she had arrived.
  • She introduced her self to me and began by informing me that she does not have much knowledge in the dentistry field and that she will need me to explain some of the dental terminology to her if needed.
  • She did state that one of the reasons why she chose to inspect this practice was due to the fact that we had a registered practice manager, regulating the activities on our registration form with the CQC and that so far she has not inspected a dental practice that has this.
  • She asked me if I have seen any of the comments left about the practice on NHS Choices and what I thought about the system.
  • She explained that during this visit she will be assessing our levels of compliance on outcomes 1, 2, 4, 6, 7 and 8.

These are the questions in which she asked:

Outcome 1:

  • Are patients involved in decision making regarding their treatment?
  • Are patients given options, are they explained and is adequate time given to make decisions about their treatment?
  • Are treatment options discussed in a private area?
  • Are patients provided with a written treatment plan and informed of related fees?
  • How would we provide treatment options and communicate with a patient who was deaf, speaks another language?
  • Asked to see the content of our patient satisfaction survey, happy with content and asked how often do we carry them out? Do we analyze the content and provide an improvement plan?
  • Asked about the methods in which we store patients details
  • How often do patients fill out medical history forms and are they checked?
  • (Advised dentists to also sign the patient’s medical form as evidence it was checked)
  • Asked me to show her an FP17DC
  • Asked me to select 5 patient record cards from the filing system. Went through each card checking paper medical history forms where consistent with the computer entries, dates tallied, Treatment plans were consistent with the treatment entered onto the computer and where signed and dated. PR Forms were filled out correctly.
  • Who is the complaints handler at the practice?
  • Asked to see our Complaints Policy, is it available in public areas?
  • Asked to see our complaints folder and look at the latest complaint and how it was dealt with.
  • Do we have a Whistle-blowing Policy

Outcome 2:

  • Do we have a consent policy?
  • How would happen in a situation where a child refuses treatment but their parents which them to have it?
  • How would we seek consent to treatment from a patient who for instance has Alzheimer’s?
  • Do we treat many disabled patients?

Outcome 4:

  • DO we have an Equal Opportunities Policy?
  • Has staff undertaken training on Equality and Diversity?
  • Do you have a Business Continuity Plan?
  • How often and who receives training in Basic Life Support?
  • Who carries out clinical audits and how often?
  • She saw our practice policy on Violent and Aggressive patients and asked if staff have received training on how to deal with this situation?

Outcome 6:

  • Do we have an Information Governance Policy?
  • How do we store patients confidential Information?

Outcome 7:

  • Have all members of staff involved with children / vulnerable adults had Enhanced CRB checks? ( Yes, very pleased as we are first dental practice she has visited where all staff involved have had this done)
  • Asked to see a copy of the practice Safeguarding children and Vulnerable Adults Policy
  • Asked to see a copy of the Child Protection and the Dental Team Booklet
  • Have staff have received training on Safeguarding Children and Vulnerable Adults?
  • Has staff received training in relation to the Mental Health Act????
  • Asked me what would we do if a child came to the practice covered in bruises and showing signs of neglect?
  • Do we have a process in place for making a referral to children’s social services, who to contact etc?

Outcome 8:

  • What is HTM01-05?
  • Do we have a practice Infection Control Policy?
  • Asked to see the latest Department of Health self assessment Audit?
  • Asked to look at the latest inspection report carried out by the PCT.

She then asked to be taken round entire practice. She asked questions to staff and sat in the waiting room asking questions to our patients.

She asked a nurse what the cycle of an instrument was and checked for dust on window sills, bases of chairs etc.

Another Inspection:

Outcome 1

  • Patient satisfaction survey
  • Checking treatment plan
  • Checked FP17DC FORMS
  • Medical History forms
  • Clinical records is batch no of LA recorded

Outcome 7

  • Has the practice done a course?
  • What is the practice policy?

Outcome 8 highest concern of CQC

  • INFECTION CONTROL POLICY
  • LDU FLOW OF INSTRUMENTS
  • INFECTION CONTROL AUDIT HTM0105
  • Maintenance OF AUTOCLAVE do you use washer disinfector

Outcome 13

  • staff induction , appraisal, practice meeting , staff welfare , recruitment policy
  • ALL NEED TO BE SUPPORTED WITH EVIDENCE
  • Inspector spoke to staff, patients and dentists.
  • Providers must man mark and engage the inspector as
  • Discussed at the last meeting

Another Inspection:
As regards the CQC visit to Teynham, they looked at the following:
1. Cross infection
2. Waste control
3. Child protection
4. Vulnerable adults
5. Patient survey
6. Staff training and CPD
7. Minutes of staff meetings
8. Staff appraisals
9. Legionella and DUWLs

Items 3 and 4 were of particular interest to them. In summary, the inspectors were very pleasant and the feedback they got from the patient interviews helped us greatly.

Practice Management CQC tips:
Tip 1 –make a list of patients the CQC could contact
Tip 2 – Make sure patients vie are taken into account in the delivery of your service. Examples are surveys and patient discussion groups
Tip 3 – Makes sure all patients receive a treatment plan and estimates of costs and that patient clearly know if their treatment is NHS or Private
Tip 4 – Make sure all staff members maintain confidentiality for the patients. There should be a confidentiality policy
Tip 5 – Make sure information is readily available to patients, e.g. patient charges poster, complaints procedure leaflet and practice information leaflet.
CQC Visit 11/6/2012:

I have divided it into three sections of questions as they spoke to our practice manager, two nurses and me.
Nurses were interviewed as a pair.

  • How long have you worked here?
  • When did you qualify?
  • How are patients treated in the practice?
  • How would we treat patients with different ethnic or religious backgrounds?
  • What do we do if there is a procedural breakdown?
  • Why do you flush the lines?
  • How do you process instruments?
  • What would you do if you saw a nurse abusing a patient?
  • This was then followed by a discussion on child abuse specifically what training have you had.
  • With me they wanted to examine notes and specifically see a prescription for a hygiene visit, record of an x-ray taken and subsequent report, letters/proof of consent, letters/proof of explaining options for treatment, recording a medical history and I had to show them around the decontamination room. They did specifically look for dated sterilized and packed instruments.
  • With Kate they ask questions focusing on outcomes 1, 4, 8, and 2.
  • They have asked her to e-mail many of our policies to include, equality and diversity, mental capacity, public protection, adult safe guarding, child protection, infection control and info governance.
  • They requested examples of audits on x-rays, record cards, they asked about legionella risk assessment, local rules for referral of children, information governance.
  • They touched on patient safety, safety of record cards to include data back up. Disaster planning for fire with record cards or all the computers dieing at the same time!
  • They were once again very interested in child protection and training for all staff. They also talk about the care pathway for the patient a lot.
  • They are ready to listen to you backing up your stance on something but will need reasons to make your statement robust.
  • They wanted to see evidence of LA serial numbers and exp dates in patients notes and also checked all our LA stock to ensure non was out of date.

Hope this helps people following us through CQC.