What CQC Expects
Smiling Matters 2023 progress report. Oral health in care homes
Smiling Matters 2023 Report [published 20/3/23]
The first Smiling Matters Report was published in June 2019, the aim was to discover if care providers were aware and implementing the Quality Standards published in July 2017. The report revealed a lack of mouth care awareness and made recommendations.
Three years on, a follow up report was carried out to find how providers had responded to the recommendations made. Inspectors went into 50 care homes and asked in -depth questions about oral health care.
Summary of the findings [2023 report]
Staff and managers are much more aware of the NICE guidance [NG48]. In 2019, only 61% were aware of the guidance. This has now increased to 91%.
Oral health assessments
There is an increase in the proportion of people having their oral health assessed when being admitted into a care home.
More than double the proportion of care plans fully covered oral health needs, compared to the review of care plans in 2019 (60% in 2022; 27% in 2019), however more work needs to be done to ensure all care plans cover oral health.
The percentage of care home staff that has received training has doubled from 30% in 2019 to 60% in 2022. However, this means 40% of staff may not receive training, which needs to improve.
Input for the dental profession
Inspectors remain concerned that people living in care homes are missing out on vital care from the dental profession – both at the right time and in the right place.
Care home providers highlighted that not enough dentists were able or willing to visit care homes to treat people who are not mobile enough to visit the dental practice.
An 'oral health champion' was recommended to promote good practice and provide a link between care homes and dental professionals, only 28% homes visited said they had done this. Whilst CQC understand the difficulties with staff turnover; they emphasize the value of having a champion.
Two questions to be asked routinely on care home inspections
These questions have been added to CQCs inspection methodology.
Do staff receive training in oral health?
How do you ensure oral health is assessed, considered and delivered as a part of a person's care plan?
The pandemic moved their priorities more towards risk and infection prevention and control but they are now re-focusing their priorities on "promoting good oral health as part of our assessment of person-centred care."
Ensure that training received includes tips and coping strategies to support people living in care homes who are resistant to mouth care and support.
New Regulatory Model [single assessment framework]
"we remain committed to include oral health in our routine adult social care inspection activity, and endeavour to make sure it remains a part of our evidence criteria under our effective and responsive key questions" CQC.
NEW Evidence requirements
CQC have developed SIX categories of evidence which they will use when carrying out an assessment. In the first category, 'People's experiences of health and care services, evidence will be gathered about people's experiences and explain that this is because they "value people's experiences as highly as other forms of information or data".
SIX CATEGORIES OF EVIDENCE
1. People's experiences of health and care services
2. Feedback from staff and leaders
3. Feedback from partners
We advise that care providers get feedback from service users [where appropriate] or family, friends, advocates on the quality of care to include mouth care support received. Obviously you will want to ensure that the feedback sheds a positive light on the service and attend to anyone's concerns.
CQC state that "If we receive feedback that people have poor experiences of care we will always identify it as a concern. We will review further and gather more evidence".
Care providers with a current rating of Requires Improvement are likely to have a re-inspection. CQC are currently looking for improvement to justify and upgrade ratings to create bed capacity within the sector. Having evidence from service users and family about the level and satisfaction of care and service provided can only act as a positive thing.
The Care Quality Commission (CQC) expects
Care managers to take account of the nationally recognised guidance including CQC Guidance from NICE.
NICE Quality Standard  recommends that residents are supported to clean their teeth and/or dentures daily and have their oral health needs assessed on admission and recorded in their personal care plans.
Quality statement 1. Oral health assessments
Adults who move into a care home have their mouth care needs assessed on admission
Quality statement 2. Recording mouth care needs in care plans
Adults living in care homes have their mouth care needs recorded in their personal care plan.
Quality statement 3. Supporting daily mouth care in care homes
Adults living in care homes are supported to clean their teeth twice a day and to carry out daily care for their dentures.
OUR ORAL HEALTH ASSESSMENT FORM Download and duplicate CLICK here
CQC, in essence would like to see care homes treat oral health as an equal priority to other personal care needs. Care homes will need to therefore document that an effective assessment of a person's oral hygiene has taken place with details of their routine check-ups as well as confirmation of whether they are exempt from NHS dental charges. Check out Looking for an NHS Dentist HERE
Signposting to local dentists and a multi-agency group
Some care homes utilise a domiciliary dental service to carry out routine checks of service users’, particularly where it is difficult to transport a particular resident. Other care homes may be able to work together with local dental practices to arrange routine appointments and emergency care.