We carried out this announced inspection on 25 October 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 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

Chrysalis Dental Practice is in Bedford, the county town of Bedfordshire and provides NHS and private treatment to adults and children. The practice provides general dentistry, implants, oral surgery and cosmetic procedures.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one allocated for blue badge holders, are available in the practice’s car park at the rear of the premises.

The dental team includes seven dentists, two oral surgeons, five dental nurses, two trainee dental nurses, one decontamination assistant, two dental hygienists, two receptionists and a practice manager. The practice has five treatment rooms; one of which is located on the first floor.

The practice is an approved training practice for dentists new to general dental practice. The principal dentist is a trainer.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected 41 CQC comment cards filled in by patients.

During the inspection we spoke with four dentists (Including the principal), one trainee dental nurse, the decontamination assistant, two receptionists and the practice manager. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5pm. On Saturdays the practice opens only for oral surgery.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider 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 provider was providing preventive care and supporting patients to ensure better oral health.
• The practice was responsive to the needs of the population and provided dental care and treatment for anyone who attended the local hospital Accident and Emergency department.
• The appointment system met patients’ needs. Patients with a dental emergency were seen on the same day.
• The practice had highly effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.
• A culture of staff postgraduate education and qualifications was embedded within the practice.

We identified areas of notable practice.

There was a strong embedded culture of professional development for all clinical staff. The principal dentist had been a trainer for trainee dentists for 21 years. We were provided with many very positive examples of staff who had excelled in their professional careers as a result of training, supervision and support provided by the principal dentist. For example, a previous trainee dentist had been accepted into a prestigious overseas dental school to undertake an advanced endodontics degree. The dentist had plans to return to work in the practice once this was completed. Another former trainee dentist was at the time of our inspection, training to become a maxillo facial surgeon and another worked as a consultant orthodontist in a hospital trust. Four dental nurses who had worked in the practice had acquired qualifications to become hygienists. Two dental nurses were currently working at the practice and were completing their hygienist qualification. The decontamination nurse and cross infection lead had attended a Masters degree in Dental Public Health and was currently undertaking their Licence in Dental Surgery (LDS). Staff praised the principal dentist for his ongoing support, dedication and encouragement for them to achieve their aspirations. This had a positive outcome for patients (and the wider NHS) who benefitted from the adopted approach.

The practice was responsive to the needs of the local population. The local hospital Accident and Emergency Department signposted people who attended the hospital with urgent dental care needs, to the practice. We were told that patients had been signposted to the practice by the hospital for approximately five years and around 250 people had been treated as a result. The practice told us this had had the benefit of relieving pressure from the hospital.

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

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken for products used for general cleaning purposes.

During our visit on 15 October 2012 we spoke with five people waiting for treatment from one of the dentists working out of the practice. People told us they were treated politely and the dentist involved them in their treatment plans. One person told us that one of the dentists drew diagrams to help them understand the proposed treatment. They told us that the dentist cared for them well and regularly asked them to complete a questionnaire about their medical condition and any medications they were taking so that they received the correct treatment at all times.

People were very complimentary about the environment and said that the décor and the facilities put them at ease. They also told us that they had confidence in the dentist and the staff that worked at the surgery. One person said, “Everyone is very nice and it makes coming to the dentist as pleasant as it can be”.

Everyone we spoke with told us that if they had to they would know how to complain and we saw evidence that complaints were dealt with appropriately and the service learnt from them. For example we saw changes to the way the service operated as the result of a complaint and the subsequent investigation.