We carried out an announced comprehensive inspection on 15 March 2017 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

Clay Cross Dental is located in premises close to the centre of the market town of Cal Cross in north Derbyshire. There are five treatment rooms, two of which are situated on the ground floor. The practice provides mostly NHS dental treatments (98%) There is a small car park for dental patients outside the practice, or a public car park a short distance away.

The practice provides regulated dental services to both adults and children. Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment.

The practice’s opening hours are – Monday to Friday: 9 am to 5:30 pm.

Access for urgent treatment outside of opening hours was by telephoning the practice and following the instructions on the answerphone message. Alternatively patients could telephone the NHS 111 telephone number.

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.

The practice has ten dentists; one hygienist/ therapist; four qualified dental nurses; three trainee dental nurses; one practice manager; and two receptionists.

Before the inspection we sent CQC comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received responses from 51 patients through both comment cards and by speaking with them during the inspection. Those patients provided positive feedback about the services the practice provides. Among the themes we identified from patient feedback were that the practice was clean, patients found the staff welcoming and friendly, getting an appointment was relatively easy and there was a consistent approach.

Our key findings were:

• The patient areas of the premises were visibly clean and there were systems and processes in place to maintain the cleanliness.
• The systems to record accidents, significant events and complaints, learning points from these were recorded and used to make improvements.
• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
• There were effective systems at the practice related to the Control of Substances Hazardous to Health (COSHH) Regulations 2002.
• Patients were able to access emergency treatment when they were in pain.
• Patients provided positive feedback about their experiences at the practice. Patients said they were treated with dignity and respect and were able to get an appointment that suited their needs.
• Dental care records demonstrated that the dentists involved patients in discussions about treatment options.
• Patients’ confidentiality was protected within the practice.
• The records showed that apologies had been given for any concerns or upset that patients had experienced at the practice.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments. However, there were some areas where refurbishment work was required.
• There was a whistleblowing policy accessible to all staff, who were aware of procedures to follow if they had any concerns about a colleague’s practice.
• The practice had the necessary equipment for staff to deal with medical emergencies, and staff had been trained how to use that equipment. This included an automated external defibrillator, oxygen and emergency medicines.

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

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

• Review the consent policy so that it makes specific reference to the Mental Capacity Act (MCA) 2005. Therefore, ensuring all staff are aware of their responsibilities under the Act as it relates to their role with particular emphasis on how it affects consent.

• Review its responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010 and consider installing a hearing induction loop to assist patients and visitors who used a hearing aid.

• Review its audit protocols to document learning points that are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.

Clay Cross Dental Care had seven dentists working at different times from one location close to the centre of Clay Cross. The current provider bought the practice in 2009; however the dental practice had actually been established for over 40 years.

We found the practice to be well organised, clean and secure. We also found the staff to be professional, with a friendly and approachable manner, which was demonstrated in the way we saw them talking with patients and visitors.

We spoke with two National Health Service (NHS) patients. Both patients said that they were quite satisfied with their dental treatment, and they had been attending the dental practice for a number of years. In one case since the practice opened 42 years previously.

One patient told us: “I am perfectly happy. He (the dentist) tells me what I need, and I need a dental expert to do that. He takes lots of time and care because he’s so good.”

The second patient said: “I am quite happy with my treatment. The dentist will tell me if anything needs doing, and I can ask questions. I have no concerns regarding confidentiality, everything is fine.”