We carried out an announced comprehensive inspection 7 July 2015 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.

CQC inspected the practice on 14 August 2014 and asked the provider to make improvements regarding assessing and monitoring the quality of service provision. We checked these areas as part of this comprehensive inspection and found this had been resolved.

The practice offers NHS treatment services for its patient population. Ayres Road Dental Surgery has one principal dentist and three other dentists, a practice manager, two therapists and five qualified dental nurses and a receptionist. At the time of our inspection there were two dentists and one therapist supported by dental nurses on duty to meet the demands of the patient population. The principal dentist and practice manager were also in attendance.

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.

The practice is open Monday to Thursday 9am to 5.15pm, Friday 9am to 4pm and Saturday 9.30am to 3pm.

We spoke with six patients who used the service on the day of our inspection and reviewed 26 CQC comment cards that had been completed by patients prior to the inspection. The patients we spoke with were very complimentary about the service. They told us they found the staff to be extremely friendly and welcoming and felt they were treated with dignity and respect. The comments on the CQC comment cards were also very complimentary about the staff and the service provided.

Our key findings were:

• There were systems in place for staff to report incidents. There were sufficient staff on duty to deliver the service. There was enough equipment available for staff to undertake their duties and we saw the premises was maintained to a good standard and was clean and tidy.

• Patient’s needs were assessed and care was planned and delivered in line with current guidance. This included the promotion of good oral health. We saw evidence staff had received training appropriate to their roles and further training needs were identified and planned through the appraisal process.

• The patients we spoke with and all the comment cards we reviewed indicated that patients were consistently treated with kindness and respect by staff. It was reported that communication with patients and their families, access to the service and to the dentists, was good. Patients reported good access to the practice with emergency appointments available the same day.

• The practice had procedures in place to take into account any comments, concerns or complaints that were made to improve the practice.
• The practice had an accessible and visible leadership team. Staff on duty told us they felt supported by the leadership team. Staff reported that patients were at the heart of the practice. This included the promotion of good oral health. Staff had received training appropriate to their roles and there was an effective appraisal system in place.

When we inspected Ayres Road Dental Surgery in September 2013 we found them to be non-compliant in safeguarding, cleanliness and infection control, medicines management, quality assurance and records. Since our last inspection the practice had been sold and there was a new service provider. The new provider had employed a registered manager to oversee day to day management and control of the service. They had renovated the premises, employed new dental and nursing staff, undertaken some training for staff, introduced policies and procedures to include safeguarding, infection control and medicines management and secured patient and staff records. They were working towards a system which ensured the quality of the service was monitored and controlled and that risks to patients using the service were properly managed.

We attended with a specialist dental adviser and observed all areas of the premises. We saw that two of the treatment rooms had been completely renovated with appropriate equipment to ensure cleanliness and security and new flooring suitable to a clinical environment. Renovation of a third treatment room was almost complete. There was a new decontamination room with the necessary equipment to meet HTM01-05 requirements. HTM01-05 is a document released by the Department of Health as a guide to decontamination in dental practice. A new reception area and waiting room area were also in use.

We spoke to three people who attended for treatment on the day of our inspection. Comments included "It's better since the new people took over", "I've been happy with the treatment", "There's been no communication about the take-over" and "The new dentist didn't seem to have my history available". None of the people we spoke with were aware of the complaints procedure or how to make a complaint if they wished to do so.

Patients were involved in all the discussions about treatment options. One of the patients told us, "The dentist explains everything, which means I can choose the kind of treatment that's best for me." Another patient told us they had difficulty in making an appointment, because only one dentist was available.

The standard of clinical record keeping was of a very good standard and reflected the quality of clinical care provided. A patient told us, "I have just been asked about my medical history and I get check-up reminders through the post."

No provision had been made for staff working at the practice to have access to guidance about safeguarding people from abuse, or the process for raising concerns about abusive practice if found. This potentially placed the health, safety and welfare of vulnerable patients at risk.

Appropriate standards of hygiene and cleanliness had not been maintained in relation to a fridge freezer and some areas of the dental practice.

Medicines and equipment for emergency use were not being stored in an appropriate and secure manner.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

The provider did not maintain a proper range of general operating policies and procedures for the practice. Essential documents pertaining to protocols, policies and procedures were not available when asked for.