We carried out an announced comprehensive inspection on 27 February 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

Dental Practice – Devon Villa is located in the town of Newton Abbot, Devon. The practice provides primary dental care services. The practice provides mainly NHS and some private patient care. There are 11 dental surgeries, with four situated on the ground floor so that patients with limited mobility can access services. The premises is a converted Victorian building, which is Grade 2 listed. This imposes limitations regarding the accessibility of the building and restricts the amount of reasonable adjustments the provider can make to the premises to meet the needs of wheelchair users. Approximately 18,000 patients are registered at the practice.

The staff structure of the practice consists of ten dentists, two hygienists, a seditionist, a locum sedation dentist and locum dentist, practice manager, six qualified dental nurses, seven student dental nurses and seven receptionists.

The practice is open from 8am to 6.30pm on Mondays and from 8am to 5.30pm Tuesdays to Friday. There is an answer phone message directing patients to emergency contact numbers when the practice is closed.

As a condition of their registration with the CQC, the provider is required to ensure that the regulated activities are managed by an individual who is registered as a manager in respect of those activities at Dental Practice – Devon Villa. At the time of the inspection there was no registered manager in place. The provider told us that the previous post holder had left and the new practice manager was undertaking the role of the registered manager. They were currently in the process of completing the application process to register with CQC.

The inspection took place over one day and was carried out by two CQC inspectors.

Ten patients provided feedback directly to CQC about the service. All were positive about the care they received from the practice. They were complimentary about the friendly, professional and caring attitude of the dental staff and the dental treatment they had received.

Our key findings were:

• 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.
• There was a lead staff member for safeguarding patients. All staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• 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.
• During the inspection patients indicated that they felt they were listened to and that they received good care from the practice team.
• The practice management was working to address unresolved concerns and complaints.
• Patients could access treatment and urgent and emergency care when required.
• Patients could book appointments up to 12 months in advance.
• Appointment text/phone reminders were available on request 48 hours prior to appointments.
• The provider had a clear vision for the practice, including driving continuing improvements to patient services.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• Staff received training appropriate to their roles and were supported in their continued professional development by the management team.

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

• Review the practice's recruitment policy and procedures to ensure all checks, including references for new staff are consistently received prior to staff employment.
• Review the processes for the repeat of clinical audits to ensure that the cycle of clinical audits are meaningful, and inspire improvement and learning.

• Review the monitoring system for the correct date stamping of sterilised dental instruments.
• Complete the gathering of safety data sheets and accompanying risk assessment in relation to the Control of Substances Hazardous to Health (COSHH) requirements.
• Complete overdue staff annual appraisals.
• Review the secure storage arrangements for paper patient notes to ensure confidentiality.

• Engage more fully with gathering feedback from patients to provide valuable information about patient services.
• Review the suitability of observation windows in treatment room doors with regard to patient privacy.
• Report notifiable events to CQC without delay.

The practice has five full time dentists and a locum providing a service to 22,000 patients. The practice has eight treatment rooms on two floors. Although there are steps up to the front entrance, level access is available via the side entrance. Two treatment rooms are on the ground floor which means people with limited mobility are able to access the service.

We saw that the practice was very clean, tidy and well maintained.

We spoke with six patients during this visit who were attending for examination or treatment. One patient said “I get excellent treatment here. I’m very happy with my dentist; I can always get an appointment”. Another patient said “They are always polite here and they always explain the options to me and help my children to understand”.

We also looked at the comments received from patients. These showed a high degree of satisfaction with the service. One patient wrote “They always give great service”.

We looked at online feedback about the practice on NHS Choices. Most patients were very satisfied. One patient said “I would like to thank the staff at the practice for the kindness and support. I would also like to congratulate the practice management on their outstanding work.”

We looked at the practice records. All records that we requested were easily found and up to date. We found that the dentist used records well to ensure safe practice and circulate information to their team.