We carried out an announced comprehensive inspection on 6 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

Cromwell Dental Practice operates from a converted commercial property and provides a mix of private and NHS dentistry. The practice is situated in the town Walton On Thames, Surrey. The practice has two dental treatment rooms; decontamination of dental instruments is mainly carried out within a designated area of each treatment room with another autoclave housed in a designated space in the kitchen area.

The practice staff consists of a dentist, a receptionist and a dental nurse. The practice also employs two part-time dental hygienists.

The practice opens:

Monday to Friday between 9.00am and 5.30pm.

The practice owner 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 inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

Before the inspection we sent Care Quality Commission (CQC) comments cards to the practice for patients to complete to tell us about their experience of the practice. We collected 19 completed cards. All the comments from patients were positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
• There were systems in place to reduce and minimise the risk and spread of infection. We did note there were areas that could be improved; these are detailed in the main body of the report.
• The practice had safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• There was a system in place for reporting incidents.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients indicated that they felt they were listened to and that they received good care from a helpful and caring practice team.
• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.
• The practice maintained a clinical governance system to underpin the clinical care provided.

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

• Review the practice’s risk assessments and ensure sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Consider providing an annual statement in relation to infection prevention control required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance is prepared.

• Consider providing the hygienist with the support of an appropriately trained member of the dental team.
• Review the availability of hearing loops for patients who are hard of hearing.
• Consider implementing a system to account for NHS prescriptions issued by the dentist to prevent inappropriate prescribing or loss of prescriptions.
• Review the practice's protocols for completion of dental records taking into account the guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

Cromwell Dental Practice is a general dental practice in Walton-on Thames offering both NHS and private treatment. The practice treats adults and children.

The premises consists of a waiting area adjacent to the reception area and two treatment rooms. There is also a kitchen area which houses one of the two autoclaves (sterilising machine).

The staff structure of the practice consists of the provider (a dentist), a receptionist and a dental nurse. The practice has the services of two part time dental hygienists who carry out preventative advice and treatment on prescription from the dentist.

Our key findings were:

We found the practice was clean, well equipped and well maintained. At our visit we observed staff were kind, caring and put patients at their ease. They were led by the provider who told us he was planning to delegate more responsibility to staff members once they were fully trained and able to do so.

We spoke with one patient on the day of our inspection and reviewed 37 comment cards that had been completed by patients. Common themes were patients felt they received very good service in a clean environment from a helpful, friendly and reassuring practice team who listened to their concerns and fully explained treatment options.

We identified regulations that were not being met and the provider must:

• Ensure infection prevention and control procedures are audited every six months to assess compliance with Department of Health guidance.
• Ensure there is an effective system in place for the safe storage and stock control of medicines.
• Ensure staff receive appropriate training in relation to their responsibilities including interim practical knowledge of how to deal with medical emergencies prior to formal training.
• Regularly assess and monitor the quality of services provided by actively seeking feedback from patients.
• Establish a process to regularly Identify, assess and manage risks to the health, welfare and safety of patients, staff and visitors to the practice.

You can see full details of the regulations not being met at the end of this report

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

• Consider making the space for the use of an illuminated magnifier to inspect dental instruments during the decontamination process.
• Document informal discussions about how the service could be improved so that any changes made as a result can be recorded and monitored.
• Regularly monitor the effectiveness of the environmental cleaning process.

Comments from members of the public were positive. The practice was