We carried out this announced inspection on 21 February 2019 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

Crescent Dental Care is in Felixstowe and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available near the practice.

The dental team includes five dentists, a senior dental nurse, nine dental nurses including one trainee dental nurse, one dental hygiene/therapist, two dental hygienists, the practice manager and a cleaner. The practice has three treatment rooms, two of which have designated separate decontamination areas at the rear of the room.

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 49 CQC comment cards.

During the inspection we spoke with four dentists, the senior dental nurse, two dental nurses, one dental hygienist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday from 8am to 8pm. Friday from 8am to 1pm and 2pm to 6pm.

Our key findings were:

• Effective leadership was provided by the principal dentist and an empowered practice management team.
• Staff felt involved and well supported by the principal dentist and practice manager and were committed to providing a quality service to their patients by ensuring their patients were their main priority.
• The practice appeared clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice staff had embedded safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs. Extended opening hours were available until 8pm from Monday to Thursday and to 6pm on Fridays.
• The practice staff dealt with complaints positively and efficiently.
• The practice had a strong culture of continuous audit, improvement and development.
• The practice asked staff and patients for feedback about the services they provided. Results of feedback were analysed and discussed at staff meetings to share learning. We noted feedback from patients was wholly positive.

We identified areas of notable practice.

We noted a mind map on the wall of the kitchen. This detailed a multitude of areas for staff education which related to the care and safeguarding of patients and how they each related to safeguarding. Areas included the definition of terms such as safe, duty of candour, capacity, consent, privacy, welfare and risk. In addition, the map detailed the definition of the each of the relevant regulations and how these related to the five questions CQC inspected by. One area of the map asked of the practice team are we caring? It then detailed an explanation of what caring meant and was followed by which regulations related to caring and what staff needed to know, such as are people treated with respect and compassion while they are receiving treatment, and do people who use the services, and those close to them receive the support emotionally they need when receiving care and treatment. The practice manager described how as a result staff had a broad understanding and were well-informed of all aspects of the service, and were empowered and confident in their role. We noted from conversations with staff across the practice how these maps and training tools had impacted on staff behaviours and values when providing care and treatment. Staff described how patients frequently commented on the positive atmosphere at the practice.

The principal dentist had systems to review the general and oral health profile of the local population and target areas for improvement. The practice manager described the extensive and effective support the hygienists provided to support young patients with high risk tooth decay. There had been detailed reviews of patients’ diet intake sheets and oral health products used to understand and clarify why the effects of tooth decay were so prevalent. On-going support and advice were given to ensure any further decay was prevented.

The practice was open 12 hours a day from Monday to Thursday and ten hours on Friday. Staff worked in two shifts from 8am to 2pm mornings and 2pm to 8pm afternoons. Each shift provided access to two dentists and one dental hygienist, each with chairside support.

The principal dentist was aware of the need for oral health support for vulnerable people and adults and children with a learning difficulty living in care homes. The practice had provided funding for three dental nurses to undertake oral health educator (OHE) training. The aim of the practice was to work with local care and nursing homes to provide demonstrations and training for care staff to ensure the best ways of providing effective oral hygiene routines to accommodate all scenarios. The principal dentist described the process they were developing for a training tool to support this. The practice also aimed to extend this to local schools and the community to inform and educate the wider public in the prevention of tooth decay in young children and adults.

The practice had introduced a system to ensure cleaning staff notified a member of the management team when they had completed the cleaning and had left the practice. This ensured there was oversight of the safety of staff who worked alone in the building.