We carried out an announced comprehensive inspection on 26 September 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

Broadway Dental Care is situated in the Cotswold village of Broadway, Worcestershire and provides private dental treatment for all age groups. It has been operated by the same dentist since 1998, initially as a sole trader and then from 2007 as Cotswold Dental Limited, a limited company. The company secretary is the practice manager and a dental nurse. They are also 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 one dentist (the Company Director) and three other dental nurses. The registered manager and clinical team are supported by a receptionist.

The practice has one dental treatment room and a separate decontamination room for the cleaning, sterilising and packing of dental instruments. The waiting room is separate from the reception area which helps provide privacy when staff are dealing with patients at the reception desk or on the telephone.

The practice is on the first floor of the building and there is no lift. The practice had carried out an assessment as required under the Disability Discrimination Act. Through this they identified that apart from fitting robust handrails there are no other changes they can make to the structure of the building to improve access for patients unable to climb stairs. They have explored the possibility of moving to different premises but none suitable are available in the village. The practice assists patients unable to use stairs to find or move to practices with suitable access.

The practice is open from 9am to 5pm Monday to Friday except Wednesdays when the practice opens by special arrangement. The practice is closed for lunch from 1pm to 2pm.

Before the inspection we sent Care Quality Commission comment cards to the practice so patients could give us their views about Broadway Dental Care. We collected 48 completed cards and spoke with two patients at the practice. The information provided showed that the practice was highly regarded by patients who were very complimentary about the dentist and the other members of the practice team. They described receiving gentle, thorough care and being treated with kindness and respect by staff. A large proportion commented on how well the dentist explains treatment to help them make decisions about their care. More than a third of patients specifically mentioned that cleanliness and hygiene at the practice was very good with several saying this was exemplary.

Our key findings were:

• The practice was visibly clean and feedback from patients confirmed this was always the case. National guidance for cleaning, sterilising and storing dental instruments was followed.
• The practice had suitable safeguarding processes and staff understood their responsibilities for safeguarding adults and children.
• The practice had clear processes for dealing with medical emergencies and for maintaining the equipment used at the practice.

• Dental care records provided clear information about patients’ care and treatment and patients received written treatment plans.
• Staff received training appropriate to their roles and were supported to meet the continuous professional requirements of the General Dental Council.

• Patients were able to make routine and emergency appointments when needed.

• The practice used in-house patient surveys, to enable patients to give their views about the practice. Staff had opportunities to contribute their views through daily discussions, regular staff meetings and annual appraisals.

• Patients’ comments showed they held the practice in high regard; they were complimentary about the practice team and all aspects of the care and treatment they received.

• The practice had comprehensive governance processes to help them manage the service and continued to review and develop these with the aim of ongoing improvement.

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

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the availability of an interpreting service for patients who do not speak English as their first language or who use British Sign Language.
• Review progress in obtaining a hearing loop to assist those who use hearing aids.
• Review the practice's recruitment procedures so they provide more specific guidance regarding information required for staff being recruited.
• Review the options available for the registered manager to receive annual appraisals.

Our inspection was discussed and arranged with the practice a couple of days in advance. This was to ensure that we had time to see and speak with staff who worked at the practice, and people who were registered with the practice. We spoke with the practice manager, a dentist, a dental nurse, a trainee dental nurse and a receptionist. We also spoke on the telephone with six people who used the practice.

People who used the practice were very complimentary about the care and treatment they received. One person said the practice was: “First Class, I would recommend it”. People told us they were given information about their treatment and the dentist: “Told me everything I needed to know”. There was medication and oxygen available for medical emergencies and staff were trained to know what to do if a person became unwell at the practice.

The practice was clean, hygienic and very well organised. People we spoke with confirmed that this was their experience too. There were suitable arrangements for the cleaning, sterilisation and storage of instruments so that people were not placed at risk of infection.

The dental team were qualified and kept their professional training up to date as required by the General Dental Council so that they knew how best to support people. The provider had systems of audits in place to enable them to monitor the quality of the service provided. People were asked for their views about the practice and these were listened to.