We carried out an announced comprehensive inspection on 29 March 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

Brewery Yard Dental Surgery is situated in a converted building in Stow on The Wold, Gloucestershire. It provides private dental care. The practice clinical team comprises of the principal dentist, a part time dentist and two qualified dental nurses. The clinical team are supported by a dental receptionist.

The principal dentist is registered with the Care Quality Commission (CQC) as 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 two dental treatment rooms. The reception area and main waiting room are on the ground floor alongside one surgery and a patient toilet.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to use to tell us about their experience of the practice. We collected 15 completed cards. Without exception patients were positive about the quality of the service provided by the practice. They gave examples of the positive experiences they had at the practice and told us the practice team were professional, caring and first class. Many patients specifically commented that the practice was welcoming, clean and tidy.

Our key findings were:

• Patients who completed CQC comment cards were all positive about the practice team and the care and treatment provided.
• The practice had an established process for reporting and recording significant events and accidents to ensure they investigated these and took remedial action.
• The practice was visibly clean and an employed cleaner was responsible for the day to day cleaning.
• The practice had well organised systems to assess and manage infection prevention and control. However there was no process in place for managing blood or bodily fluid spillages and the use of hypochlorite solution as detailed in the Department of Health infection control and prevention Code of Practice.
• The practice had appropriate safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice had recruitment policies and procedures and used these to help them check the staff they employed were suitable for their roles.
• Dental care records provided comprehensive information about patients care and treatment.
• Staff received training appropriate to their roles and were supported in their continuing professional development.
• Patients were able to make routine and emergency appointments when required.
• The practice had systems including audits to assess, monitor and improve the quality and safety of the services provided.
• The practice had systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

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

• Review the management of blood and bodily fluid spillages and the use of hypochlorite solution as described in current guidance within the practice.

When we visited the practice, we spoke with two patients, the staff on duty and the dentist/provider. Patients said the staff were good and the dentist was gentle. One patient said the staff were “lovely, always friendly and thorough.” The other patient told us “the staff are perfectly ok.”

Patients consent was gained before treatment began. Patients signed consent forms for treatment. They told us the dentist gave them options of the treatment they needed and the cost. One patient told us “I am not pressurised I was told exactly what it would cost and it was up to me to decide.”

Patients were involved in making decisions about their treatment plans. One patient us the dentist explained “the if and why [of treatment]. I am not forced to have expensive treatment.” Another patient told us the dentist “explains beforehand, what is wrong, what is needed and what it will cost. I know exactly what it [treatment] will cost and the procedure. ”

Patients were protected against the spread of infection. The staff knew the relevance of infection control. There were systems in place to protect patients from cross infection and waterborne bacteria. These systems included hand hygiene procedures, cleaning schedules, decontamination of instruments and checks and tests of equipment.

The staff were competent and suitably qualified. Staff received training to undertake their role. Clinical staff were registered with the General Dental Council (GDC) and maintained their registration through continuous personal development (CPD). Appraisals were annual which gave staff an opportunity to discuss their personal development. All staff attended safeguarding adults and children training and life support training.

Patients were asked for their views about the service through surveys. Audits and risk assessments were undertaken to manage risk which ensured quality and safety standards were maintained for patients and staff.