We carried out an announced comprehensive inspection on 19 April 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

Abbots Langley Dental Practice is situated on the first floor of a commercial building in the centre of the Hertfordshire village of Abbots Langley. The practice is accessed via an external staircase to the side of the building.

The practice provides mostly private dental treatment including fillings, crowns and bridges as well as dentures and root canal treatments to adults and children. In addition the practice provides domiciliary care to individual patients and approximately 58 residential and nursing care homes in the local area. Domiciliary care involves a dentist and nurse visiting the premises of the patients and providing simple dental treatments and check-ups in their own home.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

We received feedback on the service from 101 patients who filled out a comment card that we provided to the premises two weeks in advance of our visit. In addition we spoke with care homes that the practice provided domiciliary services to. The feedback we received was wholly positive, with many patients commenting on the friendliness of the team, and the ease at which they were able to allay the fears of nervous patients.

Our key findings were:

• Patients commented that they were treated with dignity and respect, they felt listened to, and their options for treatment were always explained to them

• The practice met the essential standards in infection control and cleanliness documented in the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05).

• Medicines and equipment for use in medical emergencies were in line with current national guidance.

• The practice had policies in place to aid the smooth running of the service, these were readily available for staff to reference, and in some cases were displayed in staff areas of the practice.

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.

• Certain clinical risk assessments, such as fire risk assessment, and Legionella risk assessment either had not been completed, or had been completed with limited detail. Following our inspection arrangements were made for these to be carried out by external contractors specialised in these areas.

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

• Review the need for a Legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review the availability of an interpreting service for patients who do not speak English as their first language.

• Review the frequency of infection control audits in line with published national guidance.

We spoke with four people who visited the practice on the day of the inspection. They said that they had been visiting this practice for a number of years except for one person who had recently moved to the area and required dental treatment. They told us that they were very happy with treatment they received. One person said, "The staff were very friendly and welcoming. The dentist made me feel at ease." Another person said," This is the only dental practice in the village. The staff are nice and helpful. The dentist discussed my treatment plan with me. I have no complaints. I would definitely recommend this practice to others."

We found that the provider was meeting the standards we had inspected. People had been provided with information about the service, opening times, various treatments and the costs. People's privacy and dignity had been respected. People were aware of the treatment options available to them and were able to make an informed decision. There were systems and procedures in place to control the spread of infection. We noted that the staff had been provided with relevant training for the work they performed. There were systems in place for assessing and monitoring the quality of service.

Abbotts Langley Dental Practice did not have access for people with mobility problems or wheelchair users. However, the provider said that people can access their domiciliary service or they would refer them to another practice.