We carried out an announced comprehensive inspection on 1 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

Buckingham House has been a dental practice for 97 years. It is situated in a residential area of Malvern, Worcestershire and provides private dental treatment for all age groups. The practice has five dentists (two of whom are the partners who own the practice), nine dental nurses, two dental hygienists/therapists and one dental hygienist. The team also includes a trainee dental nurse and an apprentice dental nurse. The clinical team are supported by a practice manager (who is also a registered dental nurse), an accounts manager and a team of reception staff.

One of the two partners of Buckingham House 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 has six dental treatment rooms and a separate decontamination room for the cleaning, sterilising and packing of dental instruments. There are steps into the building from the car park but the practice provides portable ramps to assist patients unable to walk up these. There is level access throughout the ground floor where four of the treatment rooms are located. There are waiting rooms on the ground and first floors; these are separate from the reception area which helps provide privacy when reception staff are dealing with patients. There is a wheelchair accessible patient toilet with grab rails and a call bell system.

The practice is open from 8.30am to 5pm Monday to Friday.

Before the inspection we sent Care Quality Commission comment cards to the practice so patients could give us their views about Buckingham House. We collected 48 completed cards and looked at the practice’s November 2015 patient survey results based on 116 responses. All the information we gathered about patients views of the practice were positive. Most of the comment cards included detailed comments from patients and all were positive. Patients described the dentists and the other members of the practice team as professional, courteous and caring. Many commented that their dentist provided clear explanations about the treatment they needed. Most specifically mentioned the high standards of cleanliness and hygiene at the practice. Of the 116 patients who completed a practice survey form 98% said they would recommend the practice to family or friends.

Our key findings were:

• The practice was visibly clean and feedback patients provided confirmed this was their usual experience.
• The practice had suitable child 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 the practice were actively developing their approach to this.
• Staff received training appropriate to their roles and 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, a suggestions box, social media and staff surveys to enable patients and staff to give their views about the practice.

• Patients were positive about the service provided by the practice and spoke highly of the practice team and the service 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 the practice's recruitment arrangements so an effective process which reflects relevant legislation and guidance is in place for future staff appointments.
• Review the arrangements for grading X-rays so that this is a dentist led process.
• Review the stock control arrangements for antibiotics and other medicines at the practice (including recording the dates of checks).
• Review the recording arrangements for some aspects of practice management, specifically incoming safety alert information, staff induction, mandatory training and complaints.
• Review the Legionella action plan to confirm that all actions have been completed.