We carried out an announced comprehensive inspection on 26 January 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

Smile Lincs Limited is situated in Grimsby, Lincolnshire. It offers a mix of NHS and private dental treatments to patients of all ages. The services include preventative advice and treatment, routine restorative dental care, dental implants, orthodontics and conscious sedation. The practice also accepts private referrals for endodontic treatments, dental implants and cone beam computerised tomography imaging. It is also a NHS referral centre for orthodontics and minor oral surgery.

The practice has seven surgeries, two decontamination rooms, an X-ray room, two waiting areas and two reception areas. One reception area, waiting area and three surgeries are on the ground floor. The other reception area, waiting room and four surgeries are on the first floor. There are ground floor toilet facilities.

There are six dentists, a specialist oral surgeon, three dental hygienists, seven dental nurses, five receptionists, a practice co-ordinator and a practice manager.

The opening hours are Monday to Thursday from 8-00am to 7-00pm and Friday from 9-00am to 2-00pm.

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.

During the inspection we received feedback from 23 patients. The patients were positive about the care and treatment they received at the practice. Comments included that the staff were professional, polite, friendly and attentive. Patients also commented that the surgeries were clean and hygienic.

Our key findings were:

• The practice was clean and hygienic.
• Staff were qualified and appropriately trained.
• The practice had systems in place to assess and manage risks to patients and staff including infection control, health and safety and the management of medical emergencies.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• We observed that patients were treated with kindness and respect by staff. Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• Staff worked well as a team and it was evident that they shared a goal of improving the patients’ experience.
• Patients were able to make routine and emergency appointments when needed.
• There were clearly defined leadership roles within the practice and staff told us that they felt supported, appreciated and comfortable to raise concerns or make suggestions.

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

• Complete the Infection Prevention Society (IPS) audit every six months.
• Complete an audit of dental care records and X-rays on a more regular basis.
• Document in the X-ray audit the reason why an X-ray is not of optimum diagnostic quality.
• Conduct an audit of the conscious sedation services.
• Complete immediate life support training for staff members involved in the provision of conscious sedation.
• Analyse results from the patient satisfaction surveys so that feedback can be given to staff and patients.

A patient we spoke with told us, “Everything was explained to me so I could understand it.” Another patient said, “I’ve had lots of treatment and it has always been explained to me, I’ve always had a great relationship with the dentist.”

Two patients we spoke with told us, “This is the best dentist I have ever had”, “All the staff are great”, “Everything is always explained really well which makes me feel comfortable,” and “I have no issues at all.”

We spoke with three dental nurses who were able to independently explain the signs to look for and what actions to take if they suspected abuse had occurred. The practice manager provided evidence that all staff had recently completed safeguarding children and vulnerable adults training.

One of the dentists we spoke with said, “Everything that is single use is simply disposed of, we don’t keep anything for a returning patient.”

The hygienist said, “I am lucky, I get supported by a dental nurse; most hygienists don’t get that.” A dental nurse told us, “I’ve done lots of courses at the hospital; dealing with medical emergencies, radiography, ethics.”

The clinical manager told us, “We used to complete audits for the PCT (Primary Care Trust) but that has stopped now, I still do the self assessment audits because they are really useful.”