We carried out an announced comprehensive inspection on 28 June 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

Chorleywood dental practice is a general dental practice situated in a converted house in the town of Chorleywood in Hertfordshire. They provide treatment for adults and children either through the NHS or funded privately.

CQC inspected the practice on 15 December 2014 and asked the provider to make improvements regarding cleanliness and infection control. We checked these areas as part of this comprehensive inspection and found this had been resolved.

The practice is open from 8.30 am to 5.30 pm on Monday, Wednesday, Thursday and Friday, and from 8.30 am to 6 pm on a Tuesday.

For advice or treatment outside normal working hours patients are directed by an answerphone message to contact the principal dentist directly on his mobile phone, or to contact the NHS 111 service.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

We received feedback from patients who use the practice in the form of comment cards that were made available at the practice before our inspection. 12 patients provided feedback in this way and reported a wholly positive experience at the practice.

Our key findings were:

• The practice was visibly clean and clutter free.

• Patients reported that they were seen promptly and treated with care and consideration.

• Infection control standards met national guidance.

• The practice was in the process of overhauling the governance procedures and although not yet completed, significant improvements had already been made.

• Staff demonstrated good awareness of how confidentiality is maintained in the dental practice.

• Dentists followed national guidance in the care and treatment of patients.

• The practice carried medicines and equipment for use in medical emergencies. Although some equipment recommended by the Resuscitation Council UK was missing, this was purchased immediately following the inspection.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

• Review the policy for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded.

• Review the availability of an interpreter service for patients who do not speak English as their first language, and a hearing loop to assist patients with hearing aids.

This was an unannounced responsive inspection due to concerns raised by an anonymous member of the general public about the standards of cleanliness at Chorleywood Dental Practice. During the inspection visit, an inspector was assisted by a specialist dental adviser whilst a member of the NHS local area team observed our inspection process. On arrival at the practice, the provider told us no patients were due to be treated on the day of our visit. This meant only the provider and a dental nurse (whom the provider told us was the infection control lead) were present during the inspection.

During our inspection visit, we looked at the three clinical treatment rooms, decontamination area, kitchen area and communal areas of the practice. We saw some of the practice's infection control systems and processes were not in accordance with guidance issued by the Department of Health, namely 'Health Technical Memorandum 01-05 -Decontamination in primary care dental practices (HTM 01-05)'. This included inadequate identification of 'clean' and 'dirty' areas, unclean sinks in treatment rooms and the decontamination area, an inadequate system for the manual cleaning of instruments, inadequate storage arrangements for reprocessed instruments and inadequate arrangements for the handling of clinical waste.

We had concerns these findings meant patients and staff members were at risk of the spread of infection as appropriate guidance had not always been followed.

We found there were arrangements in place to ensure the autoclave (instrument sterilising machine) remained in good working order and safe to use. There was a good supply of personal protective equipment (PPE) for use by staff members including gloves, visors, masks and aprons as well as disposable bibs, cups and protective glasses for patients. These measures meant the provider had some systems in place to prevent the risk of infection spread to patients and staff.

The people we spoke with said that they had been visiting the practice for a number of years. One person said, "I am very pleased with the treatment. The dentist are usually on time and I get an appointment straightaway and sometimes on the same day”. Another person said “The staff are pleasant and helpful. They put me at ease. I would recommend to others”.

We found that people's privacy and dignity had been respected and they had been involved in the decisions about their treatment. People had been provided with information about the service, opening times and the costs. People had a treatment plan that had been discussed with them. There were systems in place to minimise the risk and spread of infection. Staff had been provided with relevant training for the work they did include keeping their registrations up to date with the General Dental Council. There were systems in place for assessing and monitoring the quality of service.