We carried out an announced comprehensive inspection on 9 November 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.

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

Abbey Cottage Dental Practice is situated in the Herefordshire market town of Ledbury and is in the town centre. It provides mainly NHS dental treatment for all age groups and a small amount of private dental treatment. There has been a dental practice at the premises for many years and has been operated by a limited company, Abbey Cottage Dental Practice Limited for over 15 years.

The director of the company is the principal dentist and 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.

The practice has three dentists, a dental hygienist and six dental nurses. The registered manager and clinical team are supported by a practice manager and a receptionist. Some of the dental nurses also carry out reception duties.

The practice has three dental treatment rooms and a separate decontamination room for the cleaning, sterilising and packing of dental instruments. The waiting and reception areas are in the same room. The practice building is listed and has some constraints for people with mobility difficulties. There are three steps into the building from the pavement outside, two treatment rooms are on the first floor and there are also steps up to the ground floor treatment room. The practice has a portable ramp which they use to assist patients in and out of the building and the ground floor treatment room. The practice does not have its own parking.

The practice is open from 8.45am to 5pm Monday to Friday with appointments available from 9am. It closes for lunch from 1pm to 2pm.

Before the inspection we sent Care Quality Commission comment cards to the practice so patients could give us their views about Abbey Cottage Dental Practice. We collected 30 completed cards and spoke with three patients while we were at the practice. Patients were very positive about the practice and described the dentists and other members of the team as understanding, approachable and caring. Several explained that they had been patients at the practice for 10 years or more and told us that they and their families had always received professional, kind and sensitive care. A number of patients described their appreciation of the sensitive way the practice supported them to cope with their anxieties about dental treatment. Some parents said their children had grown up without a fear of the dentist because of the care the practice took. Those who commented on cleanliness confirmed that the practice was clean and tidy.

Our key findings were:

• The practice was visibly clean and feedback from patients confirmed this was their experience. National guidance for cleaning, sterilising and storing dental instruments was followed.
• The practice had suitable safeguarding processes and staff understood their responsibilities for safeguarding adults and children.
• The practice had arrangements for dealing with medical emergencies.
• Dental care records provided information about patients’ care and treatment and patients received written treatment plans where necessary.
• Staff received training appropriate to their roles and were supported to meet the General Dental Council’s continuous professional development requirements.
• Patients were able to make routine and emergency appointments when needed and gave us positive feedback about the service they received.

• The practice used the NHS Friends and Family Test, to enable patients to give their views about the practice. Staff had opportunities to contribute their views through informal daily contact with each other, staff meetings and annual appraisals.

• The practice had policies and procedures to help them manage the service and were in the process of changing over to new formats resulting in some overlap and duplication of documentation. We were aware that completion of this work was delayed by circumstances outside the registered manager’s control.

• Recruitment arrangements were in place but not sufficiently structured to provide a robust and consistent process.

• The practice used audit as a means to monitor quality in a range of areas.

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

• Review the practice’s recording arrangements for safety alert information received at the practice.
• Review the practice's recruitment procedures to provide a robust and consistent process which includes specific guidance regarding information required for staff being recruited.
• Review the availability of information about translation services for patients who do not speak English as their first language or who use British Sign Language. They should also review the provision of an induction hearing loop to assist patients who use hearing aids.

• Review and implement the practice’s X-ray audit action plan.

• Review the practice’s policies, procedures and other documentation to consolidate the recently adopted and previous versions to create one comprehensive set of documents that are tailored to the specific needs of the practice.

We spoke with six people who attend Abbey Cottage dental practice by telephone following our visit. The people we spoke with were positive about the service that they or their children received. People were complimentary about the care and attention paid to them by their dentist. One person said their family were “over the moon” with the standard of care and another described their dentist as “comforting”. Several people we spoke with told us that their whole family attended and were particularly positive about the care taken by the dentists in helping their children feel happy about going to the dentist.

We asked people whether their dentist gave them clear information about the dental care and treatment they or their children needed and any costs involved in this. People told us that everything was explained to them and their children clearly. One person told us the dentists was “approachable, he listens and talks things through, we feel involved”.

People confirmed that the dentists and dental nurses wore protective clothing such as face masks and gloves. They said that they were given protective goggles to wear during their treatment. People told us that the practice was always clean and hygienic. One person said “it always looks spotless”.

During our visit we learned that the dentist planned to create a new decontamination room for the cleaning and sterilising of instruments. This had taken some time to set in motion because the building is Grade 2 listed. In the meantime another room was being used on a temporary basis. We spoke with the infection control specialist practitioner at the Primary Care Trust about the arrangements for this room. They told us that they had recommended to the dentist that the temporary arrangements needed to be considered to ensure that infection control measures were not compromised.