We carried out an announced comprehensive inspection on 11 August 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 after immediate action was taken as a result of this inspection. Detailed feedback was given to the practice during and following the inspection and this resulted in a comprehensive action plan being developed and acted upon within a short timescale to address the concerns.

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

543 Dental Centre Limited is situated in the city of Hull, Humberside. The practice offers NHS and private dental treatments including preventative advice, domiciliary home visits, dental implants, endodontics, cosmetic dental treatment, orthodontics, conscious sedation and oral surgery.

The practice has 13 surgeries over two floors, a decontamination room connected by a hatch to a sterilisation room, six waiting areas, one oral health prevention room; four areas for the four Orthopantomogram (OPT) machines, a reception area to welcome patients and a separate area for patients to make further appointments and patient toilets on each floor. All facilities are located over three floors of the premises. There are staff facilities and offices on the second floor of the premises.

There are two managing directors, 12 dentists (including a foundation dentist, the clinical director and the chairman and a specialist Oral surgeon), two dental hygiene therapists, 22 dental nurses (one of which is a trainee and one is the practice manager), a treatment co-ordinator, nine receptionists (one of which is the head receptionist and two are deputy practice managers), two infection control support staff, two admin staff and three domestic support assistants.

The practice is open between the hours of 8am and 7pm; opening and closing hours varying from day to day throughout the week and the practice is open 9am – 12 noon on a Saturday for private patients and dental emergencies.

The practice manager is the registered manager. 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.

Our key findings were:

• The practice had systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
• The practice appeared clean and hygienic.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in accordance with the published guidelines.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Treatment was well planned and provided in line with current best practice guidelines.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The practice was well-led and staff felt involved and supported and worked well as a team.
• The governance systems were effective.
• The practice sought feedback from staff and patients about the services they provided.
• There were clearly defined leadership roles within the practice.

We found areas of notable practice that we felt should be shared including establishing a charity to support each school in the Hull area which included working with local schools to raise awareness of oral health and provide preventative fluoride treatments. This was also being adapted throughout areas within the north of England.

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

• Review the practice's recruitment policy to ensure procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Review the practice’s protocols for domiciliary visits; taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
• Review the safe storage of clinical waste and ensure this is locked and secured outside the premises.

We spoke with patients while they were waiting to see the dentist and they told us they always signed consent forms for their treatment.

Patients told us they were fully informed about their treatment plans and that they had also signed these. They told us they were kept informed if the plan needed to change. They had not all received written confirmation of their treatment plan and one patient thought this was either because they didn't need any major treatment or because they had been informed verbally. One person told us they had received a computer print out of their treatment plan.

Patients said they had received an excellent service from their dentist. They said they had recommended the centre to other people.

One patient expressed the view that 543 Dental Centre was the best practice they had ever been to. They thought the surgery provided up-to-date information and practice and said they had been encouraged to improve their dental health. They gave the centre 'ten out of ten'.