We carried out an announced comprehensive inspection on 4 February 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.

Alexander House Dental Practice is a general dental practice in St Albans, Hertfordshire offering NHS and private dental treatment to adults and children. The premises are located on the ground and first floor and consist of three dental treatment rooms, a reception area, two waiting rooms and a designated decontamination room.

The staff at the practice consist of a practice manager, a principal dentist, two associate dentists, a dental hygienist, and seven dental nurses, who also cover reception duties. One of the dental nurses is the deputy practice manager, and another is the lead dental nurse.

The principal dentist 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:

• There was an induction and training programme for staff to follow which ensured they were skilled and competent in delivering safe and effective care and support to patients.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• There were effective systems in place to reduce the risk and spread of infection. We found the treatment rooms and equipment were visibly clean.

• There were systems in place to check equipment had been serviced regularly, including the dental air compressor, autoclaves, fire extinguishers, dental laser and the X-ray equipment.

• We found the dentists and dental hygienist regularly assessed each patient’s gum health and dentists took X-rays at appropriate intervals.

• The practice kept up to date with current guidelines when considering the care and treatment needs of patients.

• The practice placed an emphasis on the promotion of oral and general health and the prevention of dental disease. Appropriate information and advice was available according to patients’ individual needs.

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available.

• 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 the needs of patients and waiting times were kept to a minimum.

• There was an effective complaints system and the practice was open and transparent with patients if a mistake had been made.

• Staff demonstrated knowledge of the practice whistleblowing policy and were confident they would raise a concern about another staff member’s performance if it was necessary.

• At our visit we observed staff were kind, caring and professional. Some staff had worked at the practice for a long time and demonstrated they knew patients well when they greeted them.

• There was an effective system in place to act on feedback received from patients and staff.

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

• 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. This includes the operation of a robust X-ray image quality assurance process.

• Ensure that all staff are familiar with the practice’s fire safety evacuation procedures and that these are practiced regularly.

• Replace the clinical and household waste bins in the decontamination room with pedal operated bins in accordance with current guidance.

• Ensure all staff are familiar with the practice waste segregation and disposal policy and procedures.

We received information of concern relating to infection control at this surgery. We looked at Outcome 9 infection control and found the surgery to be compliant. We spoke to the senior dentist and the surgery manager about the concerns raised. They responded very positively to our visit and had addressed the issues raised with the staff involved. We did not speak to anybody using the surgery on the day.

The people who use the surgery told us that they are always included in discussions on their treatment and they are given an estimate on how much their treatment costs. One person who spoke to us told us that they were an anxious patient and that the dentists were very good at putting them at ease. We were told that they always get to see the same dentist and therefore are able to build up a good relationship with them. One child we spoke with told us that they like coming here and that they always get a badge when they attend. One person told us that they had been coming here for years and wouldn’t change