We carried out an announced comprehensive inspection on 2 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

Duffield Road Dental Care is located in premises situated in the northern outskirts of the city of Derby. there are two treatment rooms one of which is situated on the ground floor. The practice provides mostly private dental treatments (60%) There is a small car park for dental patients outside the practice and there is a dedicated disabled parking spot.

The practice provides regulated dental services to both adults and children. Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment.

The practice’s opening hours were – Monday: 9 am to 8 pm; Tuesday: 9 am to 5:30pm; Wednesday: 9 am to 2:30 pm; Thursday: 9 am to 5:30 pm and Friday: 9 am to 1 pm. The practice was also open alternate Saturdays: 9 am to 1 pm.

Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message. Alternatively patients can telephone the NHS 111 telephone number. An NHS out-of-hours dentistry service also operates in Derby.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. 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 practice has three dentists; four qualified dental nurses including the practice manager; and one receptionist.

Before the inspection we sent CQC comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received responses from 43 patients through both comment cards and by speaking with them during the inspection. Those patients provided positive feedback about the services the practice provides. Among the themes we identified from patient feedback were that the reception staff were friendly, confidentiality was respected, appointments were convenient, dentists were caring and explained what was happening and the options for treatment and that the premises were clean and well equipped. Several patients said they had been coming to the practice for many years and were very satisfied.

Our key findings were:

• The premises were visibly clean and there were systems and processes in place to maintain the cleanliness.
• The systems to record accidents, significant events and complaints, learning points from these were recorded and used to make improvements.
• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
• There were effective systems at the practice related to the Control of Substances Hazardous to Health (COSHH) Regulations 2002.
• The practice had a consent policy including reference to the Mental Capacity Act 2005.
• Patients were able to access emergency treatment when they were in pain.
• Patients provided positive feedback about their experiences at the practice. Patients said they were treated with dignity and respect and were able to get an appointment that suited their needs.
• Dental care records demonstrated that the dentists involved patients in discussions about treatment options.
• The practice offered a sedation service for patients. Sedation at the service carried out safely and was in line with the national guidance.
• Patients’ confidentiality was protected within the practice.
• The records showed that apologies had been given for any concerns or upset that patients had experienced at the practice.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
• There was a whistleblowing policy accessible to all staff, who were aware of procedures to follow if they had any concerns about a colleague’s practice.
• The practice had the necessary equipment for staff to deal with medical emergencies, and staff had been trained how to use that equipment. This included an automated external defibrillator, medical oxygen and emergency medicines.

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

• Review its responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010 and consider installing a hearing induction loop to assist patients and visitors who used a hearing aid.

• Review staff training to ensure that dental nursing staff who are assisting in conscious sedation have the appropriate training and skills to carry out the role giving due regard to guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015

People we spoke with told us they were involved in decisions about their care, including treatment options and costs. This was confirmed by our observations on the day. One person told us "there is always a discussion about what choices are available. There is never any pressure the decision is always up to me".

People told us they felt the practice delivered care and treatment in a way that met their needs and felt safe when they had treatment. One person told us "Conor (the dentist) has restored my faith in dentists. I had some very bad experiences in the past but since coming to Duffield Road I feel safe. Conor is very friendly, very competent and quick in what he does".

Staff could give us examples of types of abuse and possible signs of abuse. They were also aware of the reporting procedure for safeguarding issues.

We saw that there were effective systems in place to reduce the risk and spread of infection.

The provider has effective recruitment and selection procedures in place and carries out relevant checks when they employ staff.

The provider had clear systems in place to obtain feedback from all persons involved in the service as well as auditing their own service