We carried out an announced comprehensive inspection on 14 March 2017 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

Berkeley House Dental Practice is in the Herefordshire town of Ross On Wye. The practice opened in 2006 and provides private dental treatment for all age groups. It is a very small practice with a team of five - the dentist, a dental hygienist, a dental nurse, a receptionist and a practice manager.

The practice is owned by a limited liability partnership which, as a condition of their registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run. At Berkeley House this is the dentist.

The practice has a ground floor treatment room and a separate decontamination room for cleaning, sterilising and packing dental instruments. There is level access throughout the practice apart from two steps from outside into the building. The practice has a portable ramp if a patient needs this.

The dentist and dental hygienist work part time at the practice which is open Monday to Thursday so patients can call in or telephone. Patients can also book appointments at the provider’s other practice in Ledbury. The dentist provides an emergency dental service for patients. They arrange to see them out of hours if necessary at either the Ross or Ledbury practice depending on which suits the patient. The practice has an arrangement with other practices in Ross and Ledbury so patients needing emergency dental treatment can be seen when the dentist is on holiday or attending full day dental events. The information leaflet provides telephone numbers for patients needing emergency dental treatment when the practice is not open.

Before the inspection we sent CQC comment cards to the practice for patients to give us their views. We collected 31 completed cards and spoke with one patient during the inspection.

Patients were complimentary about the service they receive and said the practice team were professional, polite and attentive.

Our key findings were:

• The practice was visibly clean and patients confirmed this was their experience. Staff followed national guidance for cleaning, sterilising and storing dental instruments.
• The practice had suitable safeguarding processes and staff understood their responsibilities for safeguarding adults and children.
• The practice had the recommended medicines and equipment needed for dealing with medical emergencies. Staff checked these to make sure they worked and were within their expiry dates.

• Staff received training appropriate to their roles and were encouraged and 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 survey forms to enable patients to give their views about the practice.

• The practice had clear governance arrangements including policies, procedures and risk assessments to help them manage the service safely.

• The practice used audits to monitor quality in a range of areas and make improvements to the service.

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

• Review the practice’s policy for recording and reviewing incidents and significant events to reflect a broader range of events.
• Review the current Legionella and fire risk assessments giving due regard to national guidelines that such assessments should be completed by persons with the necessary skills, knowledge and experience to do so.
• Review the practice’s arrangements for monitoring that the refrigerator temperature is monitored and recorded.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 as it relates to their role.

We spoke to eight of the dentist’s patients either in person or by telephone. Four of these people mainly went to the Ross practice and four to the Ledbury one. Some of them also told us about the experiences of their partners or children.

People were pleased with the service they received at the practice. Everyone said that the dentist and the rest of the dental team were friendly. People made comments such as, “it’s a nice dentist to go to” and, “he is very kind”. People felt that they were given clear information about what treatment they needed and why. One person described the dentist giving them, “a painstaking and tailor-made treatment plan”.

There was medication and oxygen available for certain medical emergencies. Staff were trained to know what to do if a person became unwell at the practice.

The practice was clean and people we spoke with told us they thought standards of cleanliness were very good there. There were suitable arrangements for the cleaning, sterilising and storing of instruments. Staff described these procedures to us confidently.

The dental team were qualified and maintained their continuous professional development (CPD) as required by the General Dental Council (GDC). The staff files contained clear evidence of this.

The practice had arrangements for monitoring the quality of the service and for assessing and reducing any risks to people using the service, or staff.