We carried out an announced comprehensive inspection on 11 January 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

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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. In addition to the principal, the practice engaged two associate dentists, a hygienist, and employed three trained dental nurses, with one nurse having lead responsibility for managing reception. The practice manager is also a trained dental nurse. All the dental nurses work as a team and are responsible for the cleaning of the practice.

The practice is located at ground level within a range of shops and is accessible to wheelchair users. Due to building constraints the toilets are not accessible for patients with limited mobility but disabled toilet facilities are located nearby.

The practice had two treatment rooms, a staff kitchen area, reception and waiting room and one decontamination room for cleaning, sterilising, and packing dental instruments. The practice is open Monday to Thursday 9.00 am to 5.00 pm, Fridays 9.00 am to 1.00 pm. For private patients, the practice has extended opening hours available.

We spoke with four patients during our inspection and received 41 comments cards that had been completed by patients prior to our inspection. We received positive comments about the cleanliness of the premises, the empathy and responsiveness of staff, and the quality of treatment provided.

Four patients told us that staff explained treatment plans to them well. Patients reported that the practice had seen them on the same day for emergency treatment. Patients commented that the service they received was good, and that they were always clear about the costs involved in their treatment.

Our key findings were:

• Staff had received safeguarding training and knew the processes to follow to raise any concerns.
• Staff had been trained to deal with medical emergencies and appropriate medicines and life-saving equipment were readily available and accessible.
• Infection control procedures were in place and staff had access to personal protective equipment.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits, and risks and were involved in making decisions about them.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• The practice staff felt involved and worked as a team.
• We found that systems, and risk assessments, were in place to give oversight and ensure compliance with regulations, and safety however we found that the management of some medicines was not adequately robust to keep patients safe.
• We found that regular audits of X-rays were not in place to manage performance, identify risks, mitigate, and drive improvements.

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

• Ensure safe storage and robust stock management of medicines that could be dispensed to patients.
• Ensure audits relating to X-rays are undertaken at regular intervals to help improve the quality of service.
• Record peer review discussions for future and reflective learning.

All of the people we spoke with during our visit on 19 October 2012 told us that their dental treatment was satisfactory and met their needs. One person said, "I have all my teeth because I have had regular appointments and have been told about the best way I should look after my teeth." One young person who was accompanied by their parent said, “I am ok about coming here. The dentist usually asks me if I feel OK. Today they explained to me about the treatment that I needed".

We noted that staff treated people with respect and spoke to them politely. People who were paying privately had been informed about the cost of their treatment and what they had been expected to pay prior to agreeing to their treatment. They told us they had been given options and choices about their treatment. People unanimously said that the staff and the dentist were polite and had treated them with respect.

We saw that people’s treatment records were up to date, although the provider may wish to note that it was not evident that the dentist, or the reception staff, had always ensured they knew the person's current health and if they were taking any medication.

The provider may wish to note that people were not aware of how the practice was safeguarding children and vulnerable adults.