We carried out this announced inspection on 16 April 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Chipping Manor Dental Practice is in Wootton-under-Edge and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available behind the practice and in the surrounding streets.

The dental team includes seven dentists one of whom is a foundational (trainee) dentist, seven dental nurses and two trainee dental nurses, two dental hygienist/therapists, a decontamination technician, five receptionists a practice manager and a clinical manager. The practice and clinical manger share the day to day running of the practice. The practice has six treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Chipping Manor Dental Practice was the principal dentist.

On the day of inspection we collected 140 CQC comment cards filled in by patients and spoke with three other patients.

During the inspection we spoke with four dentists, four dental nurses, one dental hygiene/therapist, two receptionists and both the practice and clinical manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday and Wednesday 08.15 am – 5.30pm
• Tuesday 08.30am – 5.30pm
• Thursday 08.30am – 9.00pm
• Friday 08.15am – 5.00pm
• The practice is closed at weekends.
• Out of Hours information was displayed on website and in the practice leaflet.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and a culture of continuous improvement.
• Staff felt involved, supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

We identified an area of notable practice.

• The whole team are involved in Bridge to Aid overseas offering treatment and development of clinics. They make an annual vist for this provision.
• The practice holds children’s days with a focus on prevention of dental decay. They are themed days and all staff dress up in the theme and encourage the children to do so. The resultant impact is nervous children will let a fellow pirate look in their mouth.
• The foundation dentist and a nurse undertake oral health visits to schools.
• The practice has a dedicated children’s waiting room in which child friendly material and child oral health care manuals are available.

The resultant impact is:

• Parents are bringing their children, and attending themselves, more regulary.
• The days provide a way to relieve anxiety and in new patietns and increase cooperation theough the themed image.
• Parents/carers talk about a “spirit of acceptance” and report the enthusiasm on the day is infectious.
• Extensive oral hygine advice tailored to the child and family needs is provided with the aim of preventing long term oral disease.
• Childhood fear of dentist is reducing thus preventing a barrier to treatment in later life.
• Better implementation of of Delivering Better Oral Health guidelines.
• There have ben no child referrals for extraction under general anaestheic in at leastr the last three years.
• Dentist have seen a reduction in plaque levels and dental decay in children attending the practice.
• One of the trainee nurses was so inspired by the day they have entered the profession.

There were areas where the provider could make improvements. They should:

• Review the practice infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.

  • Review the use mechanical assistance in cleaning instruments for greater effectiveness.
  • Review the storage of unwrapped daily instruments in drawers in the decontamination room where there is no positive air flow thus there is a risk of aerosol contamination.
  • Review the practice protocols for managing “never events” and consider the introduction of the World Health Organisation checklist to ensure prevention of wrong site treatment.

We spoke with four people who were visiting the dental practice for treatment or examination. People we spoke with told us "this is an excellent practice, it must be the best in the county, I couldn't wish for anything better", "the dentist has patience", and "I would recommend this practice (and I have done) as the service is second to none”, “he (the dentist) is so kind". People told us the dentist listened and explained treatment options; one person told us "staff are really professional, so considerate, a premier, first class service is provided".

We found people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care and people's privacy people experienced care, treatment and support which met their needs and protected their rights

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from the risk of infection because appropriate guidance had been followed.

People can be assured that the services provided are monitored for quality as the provider had effective systems in place.