We carried out an announced comprehensive inspection on 8 November 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

Clowne Dental Surgery is located on two floors of premises situated in the centre of the village of Clowne in north Derbyshire. There are two treatment rooms, one on each floor. The practice provides mostly NHS dental treatments (60%). There is a car park to the side of the dental practice for patient parking.

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 6 pm. The practice is also open on alternate Saturdays: 9 am to 1 pm.

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

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.

The practice is registered with the Care Quality Commission (CQC) as a partnership.

The practice has two dentists; one qualified dental nurse; two trainee nurses and one part time receptionist. Dental nurses also work on reception.

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 39 patients who provided positive feedback about the services the practice provides.

Our key findings were:

• 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 were not robust.
• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
• There were not effective systems at the practice related to the Control of Substance Hazardous to Health (COSHH) Regulations 2002.
• Staff at the practice had a limited understanding of consent, particularly in relation to the Mental Capacity Act 2005 and Gillick competency, a legal precedent where a child may give their own consent to treatment.
• Patients said they had no problem getting an appointment that suited their needs.
• 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 the dentist involved them in discussions about treatment options and answered their questions.
• Patients’ confidentiality was protected.
• 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.
• 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 system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.

• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.

• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities.

• 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.

During our inspection we spoke with four people who used the service, three members of staff and the registered manager.

People told us they were happy with the care and treatment they received. One person said, “The care here is excellent”. Another person said, “When I came in with a problem with my tooth, it was sorted straight away”.

People told us they were treated with respect and were involved in the planning of their treatment. We saw that there were effective systems in place to enable staff to be responsive to the needs of people with disabilities.

Care and treatment was based upon clinical guidelines and individual need, and people told us they were treated with care and compassion. We saw that people were kept safe because they were cared for and treated by staff who had the appropriate knowledge and skills to meet their needs.

During our inspection we saw that the practice was clean and tidy. We observed staff following policies and procedures to protect people from the risks associated with infections.

There were systems in place to assess and monitor the quality of the service. We saw that these systems were used to improve the quality of the service.