We carried out an announced comprehensive inspection on 18 August 2015 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.

CQC inspected the practice on 17 December 2014 and asked the provider to make improvements regarding;

• Cleanliness and infection control,
• Safety and suitability of premises,
• Complaints
• Records.

We checked these areas as part of this comprehensive inspection and found these had been resolved.

Apex Dental Care – Woking is also known as Oasis Dental Care Woking – Knaphill. It is a general dental practice in Knaphill, Surrey offering NHS and private dental treatment to adults and children.

The premises consist of a waiting area, a reception area and five treatment rooms. There is also a separate decontamination room.

There are five dentists at the practice, five dental nurses, a trainee dental nurse, four receptionists, a practice coordinator and a practice manager. The practice employs the services of two part time dental hygienists who carry out preventative advice and treatment on prescription from the dentists. The practice manager is 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.

Our key findings were:

• There were effective systems in place to reduce the risk and spread of infection. We found the treatment rooms; decontamination room and equipment appeared clean.

• There were management systems in place to check all equipment had been serviced regularly, including the suction compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• Staff demonstrated knowledge of the practice’s whistleblowing policy and were confident they would raise a concern about another staff member’s performance if it was necessary.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• We observed that staff were kind, caring and put patients at their ease. Staff were motivated and enjoyed working together as a team

• We reviewed 25 Care Quality Commission (CQC) comment cards that had been completed by patients which all reflected positive experiences of care and treatment. Common themes were patients felt they received clear explanations of treatment from a caring and helpful practice team in a safe and hygienic environment.

• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.

• The practice kept up to date with current guidelines when considering the care and treatment needs of patients.

• There was an effective system in place to act on feedback received from patients and staff.

• There were systems in place to assess, monitor and improve the quality of service provided

This was an unannounced responsive inspection due to concerns raised by patients who had visited the practice about the standards of cleanliness and safety whilst building works were being undertaken. During our inspection we spoke with three dentists, four receptionists, four dental nurses, an administrator and the interim practice manager (who had been seconded by the provider from another location in the last week since the departure of the previous practice manager). At the time of our inspection, the practice had recently been acquired by Oasis Dental Care and the associated registration paperwork was in the process of being completed.

We had concerns the provider did not have an effective system in place to assess the risk of and prevent the spread of infection. For example, there was no policy in place for manual scrubbing of instruments prior to decontamination; clinical waste was not securely stored prior to collection and the provider had not assessed their decontamination facilities for compliance with Department of Health guidance as required, every six months.

We had concerns there was a lack of adequate cleaning equipment which was not always segregated from equipment used by the builders. Staff members had not been able to follow their usual environmental cleaning schedules; the provider had not assessed the risks this posed on standards of cleanliness and hygiene. We found the treatment rooms and communal areas were clean on the day of our inspection. We found the decontamination and reprocessing of dental instruments was mostly in line with guidance.

We had concerns about the safety, security and suitability of the premises. For example, the provider had not fully assessed their premises to facilitate access for people using wheelchairs; the premises was not secure at night as the alarm had been switched off to facilitate access to the builders; there was no effective system in place to prevent unauthorised access to the premises during operational hours; on going building work meant patients and staff members had to endure strong adhesive and paint fumes.

There was not an effective complaints system in place. We had concerns the complaints system had not been bought to the attention of people using the service and people were not appropriately supported to bring about a complaint or suggestion.

We had serious concerns about the security of people's confidential information, some of which we found stored in a bath tub accessible to staff members and building contractors. Records relating to the management of the service were inappropriately stored and could not be promptly located when required.

We spoke with three patients after they had received treatment on the day of our visit. All these patients were happy overall with the treatment they had received over the time they had been attending the practice. Where appropriate they had been given treatment options and the information they needed to be able to make their choice. One remarked that options had been, "Fully explained". Another commented that there had been "good communication" between her and practice staff who had been "very helpful". They felt that their decisions and opinions were respected by the staff.

We found that people were given appropriate information about their treatment. Information was collected and updated about patient's medical conditions to ensure they remained safe when being treated.

Equipment was available and staff were trained to deal with medical and other foreseeable emergencies. Effective systems were not in place to reduce the risk and spread of infection. There were insufficient sinks in the decontamination room and inappropriate floor coverings in part of two of the dental surgeries.

Staff were appropriately trained and patient information was kept and stored securely.