We carried out an announced comprehensive inspection on 28 July 2015 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 practice was registered with the Care Quality Commission in May 2014 but has only been open for patients since September 2014. This means that some of the processes we would expect to see were not in place on the day of our inspection because the practice had been operating for less than 12 months. However they had been planned. This included annual appraisals and an audit timetable.

The practice employs three dentists who undertake mainly private treatments with a small amount of NHS dental treatment. They are supported by three dental nurses. There is one receptionist working at the practice who also undertakes other administrative functions. Other clinicians also attend the practice but are not employed there. These included a hygienist and a periodontist. The practice has three surgeries and a dedicated decontamination room.

The lead dentist is the responsible person. This is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘responsible persons’ and 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 open Monday to Thursday between the hours of 8.30am and 5.45pm and Fridays between the hours of 8.30am and 4pm. They are also open on one Saturday each month.

On the day of the inspection we spoke with three patients who told us that they were satisfied with the services provided at the practice. They told us that they were treated with kindness, dignity and respect and their privacy was maintained. They said that explanations and costs were clear and they were involved in the decisions about their care and treatment.

We viewed CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. There were 49 completed comment cards and all of them reflected positive comments about the staff and the services provided, describing the clinical and support staff as kind and caring. The comments made in the CQC cards reflected that patients were extremely satisfied overall with the services provided at the practice.

Our key findings were:

• There were systems in place to manage safety incidents and complaints and to cascade any learning from them to staff.
• There were sufficient supplies of emergency medicines and equipment and staff had been trained in their use. One recommended medicine was not available in the event of an emergency.
• Risks to patients and staff had been assessed and managed effectively. National patient safety and medicine alerts were monitored and acted upon.
• Infection control procedures were being followed but minor improvements were required.
• Radiation protection documentation was incomplete to reflect that X-rays were being safely taken but this was rectified immediately after our inspection.
• Emergency medicines were being checked regularly to ensure they did not expire. One recommended item was not being kept.
• Recruitment processes were generally robust but some supporting documentation was absent from some staff records. There was no written induction process for new members of staff to follow.
• Staff were being appropriately supported and trained and an annual appraisal process was in place.
• Treatments and consultations followed guidance from the National Institute for Health care Excellence.
• The appointment system met the needs of patients including access to emergency dental care.
• The practice was well-led and the lead dentists set standards for staff to follow and monitored them.
• Patient and feedback was sought and monitored through the use of a continuous patient survey. Staff feedback was sought informally, at staff meetings and at appraisals.

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

• Improve recruitment procedures to ensure that employment records contain the necessary documentation to reflect robust recruitment processes and that structured inductions take place. This includes ensuring that health care professionals attending the practice and not employed there have appropriate skills and qualifications.
• Review the emergency medicines to ensure that those recommended by the BNF and Resus Council are available in the event of a medical emergency and review having immediate access to an AED as per Resus Council recommendations
• Review infection control procedures in order to more fully comply with the recommendations of HTM 01-05 for the cleaning and sterilising of used dental instruments.
• Implement a system to provide an audit trail for action when areas for improvement are identified through audit or other monitoring of the services provided.
• Monitor and record fridge temperatures to ensure dental equipment and medicines remain effective.
• Improve the content of patient notes to better reflect consent and that risks and patient involvement with their care and treatment.
• Provide a list of external contacts that staff can contact for safeguarding concerns.
• Ensure dentists are aware of the “Delivering Better Oral Health Toolkit” and how to apply it to patients. Ensure all staff are aware of Gillick consent in relation to children under the age of 16.