We carried out an announced comprehensive inspection on 13 October 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

Oasis Dental Care - Lincoln 2 is a mixed dental practice providing private and NHS dental care for both adults and children. Where private treatment is provided some is provided under a fee per item basis and some under a dental insurance plan. The practice holds an NHS contract for the provision of orthodontic treatment on a referral basis only. The premises in which the practice is situated is a one storey purpose built facility with all services available on one level. At the time of our inspection there was no wheelchair access to the building.

The practice has eight dental treatment rooms, all on the ground floor. There is a separate decontamination room used for cleaning, sterilising and packing dental instruments, a patient recovery room and X-ray room. There is also a reception and waiting area and other rooms used by the practice for office facilities and storage. The practice is open from 8.00am to 7.00pm Monday, Tuesday and Thursday, from 8.00am to 8.00pm on Wednesdays, from 8.00am to 5.00pm on Friday and on alternate Saturdays from 09.00am to 1.00pm.

The practice has seven dentists who are able to provide services including the provision of dental implants (a dental implant is a metal post that is placed surgically into the jaw bone to support a tooth) and orthodontic treatment (where malpositioned teeth are repositioned to give a better appearance and improved function). They are supported by ten dental nurses, two dental hygienists, a practice manager and five receptionists.

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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We also spoke with patients on the day of our inspection. We received feedback from 32 patients. These provided an overwhelmingly positive view of the services the practice provides. Patients commented on the high quality of care, the kindness and care shown by staff, the cleanliness of the practice and the professionalism of staff.

Our key findings were:

• Patients commented that they were happy with their care, staff were helpful and professional and appointments were flexible.

• The practice had good facilities and was well equipped to treat patients and meet their needs. However the practice did not have access to a translation service for patients who did not speak English or have a hearing loop to support patients with a hearing aid.

• The practice appeared very clean and well maintained and infection control standards were in line with national guidance.

• The practice had carried out a Disability Discrimination Access audit and as a result planned to provide wheelchair access and provide disabled parking space.

• The practice had medicines and equipment for use in a medical emergency which were in accordance with national guidelines.

• There was not always an individual risk based approach to patient recalls or fluoride varnish applications for children in line with national guidance.

• On the whole staff had received training and support appropriate to their roles and were up to date with their continued professional development (CPD). However we found that one clinician was not up to date with radiation training and the dental hygienists were not always supported by a dental nurse.

• Staff reported incidents and these were investigated and learning implemented to improve safety.

• Governance arrangements were in place for the smooth running of the service. However some staff appraisals were overdue but had been scheduled.

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

• Review the practice’s protocols and adopt an individual risk based approach to patient recalls giving due regard to National Institute for Health and Care Excellence (NICE) guidelines.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’
• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment, support and supervision of all staff, including staff appraisals.
• Review the current staffing arrangements to ensure all dental staff, including hygienists are suitably supported by a trained member of the dental team when treating patients in a dental setting.
• Review the availability of a hearing loop for patients with hearing difficulties.

As part of our inspection we spoke with staff and looked at records.

Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We saw people were treated with dignity and respect. There were systems in place which enabled people to express their views' about the services and care they received.

We found that people were given choices about the treatment they received. For example we saw in one record a preference for composite rather than amalgam fillings was recorded. In another record we saw a person had been given a choice of having a crown, temporary crown or denture.

We observed people received information about their treatment and appropriate consent was obtained before treatment commenced.

We saw people were cared for in a clean environment and protected against the risk of infection.

We looked at the outcomes of patient surveys and saw people were happy with the care and support they received. We observed where people were not happy their concerns had been taken into account and the issues resolved.