We carried out an announced inspection of this practice on 20 January 2016 where breaches of legal requirements were found. After the inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to safe and well led care and treatment.

We undertook this focused inspection to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for A B Smith - The Old Filling Station on our website at www.cqc.org.uk

Our findings were:

Are services safe?

We found that this practice was providing safe 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

The practice offered private dental treatment to patients of all ages. This was a single handed principal dentist supported by a dental hygienist and two dental nurses in addition to a practice manager.

Dr Anthony Smith the principal dentist is the registered provider for the practice. 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.

The practice has two treatment rooms, a reception/waiting area and a decontamination room. The practice is open on a Wednesday and alternate Thursday from 9.00am until 1.00pm.

Our key findings were:

• Emergency medicines were now in date and easily accessible.
• The practice was in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• The registered provider had ensured that audits for infection control, clinical and non-clinical records were in place.

We carried out an announced comprehensive inspection on 20 January 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 not 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 not providing well-led care in accordance with the relevant regulations.

Background

The practice offered private dental treatment to patients of all ages. This was a single handed principal dentist supported by a dental hygienist and dental therapist and two dental nurses in addition to a practice manager.

Dr Anthony Smith the principal dentist is the registered provider for the practice. 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.

The practice has two treatment rooms, a reception/waiting area and a decontamination room. The practice is open on a Wednesday and alternate Thursday from 9.00am until 1.00pm.

We viewed 27 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. In addition we spoke with two patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice. They commented staff were caring and respectful and that they had confidence in the dental services provided. Patients told us they had no difficulties in arranging a convenient appointment and that staff put them at ease and listened to their concerns.

Our key findings were:

• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to manage medical emergencies.
• Patients commented they felt involved in their treatment and that it was fully explained to them.
• Patients were able to make routine and emergency appointments when needed. There were clear instructions for patients regarding out of hours care.
• During our visit we observed staff were kind, caring, competent and put patients at their ease.
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current regulations.
• 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 their confidentiality was maintained.

We identified regulations that were not being met and the provider must:

• Put in place audits of various aspects of the service, such as dental care records and infection control are undertaken at regular intervals to help improve the safety and quality of the service. The practice must also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure that Medicines and Healthcare products Regulatory agency safety alerts are responded to and effective incident reporting is in place.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure the right medicines are in place for a medical emergency

You can see full details of the regulations not being met at the end of this report.

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

• Review the practice's recruitment policy and procedures to ensure character references for new staff as well as proof of identification are requested and recorded suitably.
• A full range of Personal Protective Equipment (PPE) should be continually available for staff.

We spoke with five people using the service when we visited who all commented that they were happy with the service they received. They all said they saw the dentist regularly and felt the care they received was "excellent". They told us that this was "A really good dentist" and that they would "Happily recommend the practice to anyone".

The people we spoke with confirmed that the dentist, dental nurses and the therapist/hygienist always explained what they were doing, what was found during examinations and the treatment options available. They confirmed they received information to enable them to decide upon treatment options and knew what the costs would be. Some of the people we spoke with had been using the dentist for over thirty years and one said that "It does rather show how good he is, I would have gone elsewhere long ago if I had not had first rate service all those years."

The provider had systems to assess and monitor the quality of service that people received. We found that there were good infection control measures in place to protect people from the risk of infection and appropriate guidance had been followed. Surgical instruments were cleaned and stored correctly. Emergency care could be given because staff had been trained in what to do in medical emergencies.

Patients confirmed that the practice always appeared very clean and fresh and that staff always used protective equipment when treating them.