People’s personal records including medical records were not always accurate and fit for purpose. Important records requiring patient signatures and dates of treatment were not always being fully completed or signed by the patient.

Our inspection of 22 July 2013 found that people were not adequately protected from the risk of unsafe or inappropriate care and treatment arising from a lack of proper information about them. Electronic records did not show how patients' options for treatments, the advantages and risks associated with these treatments were being discussed and recorded. We wrote to the provider and they told us that they would review their procedures. We returned on 10 October 2013 and found that while some improvements had been made, there were inconsistencies in both paper and electronic records.

We looked at nine electronic and paper records of patients receiving a service from Castelnau Dental practice between 16 September and the 10 October 2013. Electronic records showed clearly the comparisons between the risks and benefits of each option available to patients. Key paper documents including consent to examination and treatments called Practice Record Form Patient Declaration and Treatment Plans were either not signed and/or not dated.

We were informed by staff that they had not started to audit and monitor records as part of their wider audit process, which meant that errors and omissions of information were not being identified and addressed.

During our inspection we spoke with eleven people who used the service. We asked people how involved they were in decisions about their care and treatment. Someone said "My dentist involves me in all the treatments and choices we discuss". We asked people how their consent was sought. While some people remembered signing for treatments the majority of the people explained that they discussed their care with the dentist and agreements were informal. Each of the people we talked with spoke commendably about the dentists and staff. One person told us "My dentist is very good; they explain the procedures thoroughly".

Our inspection of December 2012 found that staff at Castelnau were unaware of how to address potential cases of abuse or the actions they should take. We returned in July 2013, and found that staff had received training. The safeguarding policy had been reviewed. In 2012 the practice was not operating systems designed to regularly assess and monitor the quality of the service provided. At our inspection in July 2013, we found that the provider had reviewed their polices and was providing feedback opportunities to people using the service.

We spoke with dental staff and asked them about their development. Staff gave examples of how they wanted to pursue their clinical skills and advance their knowledge.

We looked at records and found inconsistencies in how information was recorded. While some people's records were complete, others lacked sufficient detail.

We inspected this service on 7 December 2012 and found that cleaning schedules were not being checked and there were concerns with aspects of the cleanliness and hygiene. The provider sent us an action plan advising how this would be addressed. We visited again in April 2013 as part of a follow up inspection and spoke with six members of staff.

Some staff explained that they were aware of the most recent decontamination procedures and national guidelines. Someone told us "we have a new cleaning schedule for staff to follow". We checked the daily cleaning records in two surgeries and these were being completed more often than on our previous visit. The provider may wish to note however, the records were not completed on a daily basis and so there were gaps in the recording of cleaning schedules.

We also found that storage of data relating to the testing of one of the sterilizing systems was poor. Most staff explained that endodontic files used for root canal treatment were not re-used on other clients, bit other staff were not sure whether endodontic files could be re used on other clients after sterilization.

We were shown new dirty to clean zones in two surgeries and new processes for separating the washing and rinsing of used instruments. One staff member said "we have marked out the dirty to clean zones for staff to follow to reduce the risk of contamination". These guidelines were clearly marked and visible for staff to follow.

We inspected Castelnau dental practice as part of a responsive review following information of concern we had received about the practice. We spoke with five staff and asked them to show us how the practice was cleaned and how instruments used for dental were cleaned and maintained. We asked staff to show us instruments used at the practice and how these were prepared for use and stored following cleaning. We asked to view records and cleaning schedules at the practice and discussed how these records were recorded, maintained and updated.

We also asked to look at how the practice monitored its service and the processes it used to audit cleaning, the preparation and use of equipment and other essential aspects of the service. We asked to look at records and documents relating to monitoring and audit, however the practice maintained insufficient records and documents to support effective audit.

The practice had a child protection policy but there was no vulnerable adult policy and staff had not completed recent training in relation to safeguarding. There were very few details in records and documents for us to inspect related to the safeguarding and protection of vulnerable children and adults. As part of our inspection we consulted with a specialist dental lead, the British Dental Health Association (BDHA) and the General Dental Council (GDC).