We carried out this announced inspection on 30 August 2018 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

Dental Dimensions Centre is in Launceston and provides private treatment to adults and children.

The premises are a converted grade 2 listed residential building, which means there are restrictions on alterations that can be made to it. Although there are ground floor treatment rooms, access and facilities for wheelchair users and/or parents with pushchairs is restricted. Car parking spaces, are available near the practice in public car parks.

The dental team includes two dentists, a dental hygiene therapist, a team of dental nurses/trainee dental nurses, decontamination room operative, receptionists, treatment coordinators and a practice management team. There are four treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered managers at Dental Dimensions Centre are the principal dentist and the practice manager, who share the role.

On the day of inspection we collected 14 CQC comment cards filled in by patients and spoke with one other patient. This gave us a positive view of the practice.

During the inspection we spoke with all staff on duty. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9am – 5pm (closed for lunch 12:30pm – 1.30pm).

Our key findings were:

• 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 suitable 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• Information governance processes for the use of CCTV in and at the premises were under review.

There were areas where the provider could make improvements. They should:

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’ In particular regarding the availability of a hot water for hand washing purposes and tears to the fabric of two dental chairs.
• Review the practice’s protocols for audit cycles specifically with the view to include patient record cards and antimicrobial prescribing.

We phoned the practice to give three working days' notice of our visit. During our visit to Dental Dimensions Centre we made a tour of the premises and met with the registered managers, one of whom was the principal dentist, and two other staff on duty. We contacted five people who used the service either by phone, email or we met with them in the waiting room.

People told us the dentist explained clearly any need for treatment. They told us the options for treatment were explained and they were able to make choices. One person said, “They are second to none, their teaching is brilliant.” Another said, “They are perfect professionals.”

We found that the practice had systems in place to protect vulnerable people and staff knew how and when to obtain support for people.

We found that there were good and reliable systems in place to maintain a safe and hygienic service.

We found that there was a suitable complaints system and that the practice manager had responded promptly to any issues raised.

We met with two people while they were waiting for their appointments. One person told us their treatment had been ”fantastic”; they had previously had on-going problems, but here the dentist had “got to the bottom of it.” We saw that they were given advice about maintaining their oral health.

People told us that the dentist had “gone through the options” with them. They had been offered choices of treatments, and told how much they would cost. They had confidence in the diagnosis, and said they now felt loyalty to this practice.

The service was set in a listed building with steps to the front door. One treatment room was on the ground floor. The waiting area was very comfortable, with a choice of sofas, easy chairs and upright chairs. There was an attractive heater with the appearance of a coal fire and a choice of water or coffee. Upstairs were two treatment rooms, the treatment planning room, and the bathroom.