We carried out an announced comprehensive inspection on 13 December 2016 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

Elder Tree Dental Practice is a dental practice situated in a converted property on Canvey Island, Essex. The practice has four treatment rooms, two waiting rooms and a reception area. Decontamination takes place within treatment a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the

treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

The practice offers NHS and private general and cosmetic dental treatments to adults and children.

The opening hours of the practice are 9am to 5.30pm Monday to Thursday. Appointments are available from 9am to 1pm and 2pm to 5.15pm. The practice is open between 9am and 5pm on Fridays and appointments are available up to 4.45pm. Evening appointments are available up to 7.30pm on Monday or Tuesday evenings and the practice is open between 9am and 1pm on alternate Saturdays. Emergency walk in appointments for urgent treatment are available each day between 11am and 12pm. The practice closes between 1pm and 2pm for lunch.

The practice has a principal dentist, four associate dentists, four dental nurses and two receptionists.

The practice is registered with the Care Quality Commission (CQC) as an individual. The principal dentist is the ‘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.

We received feedback from 22 patients who completed CQC comment cards prior to our inspection visit. We also spoke with four patients during the inspection visit. Patients made positive comments about the excellent care and treatment that they received. They also commented positively about the cleanliness of the premises, the kindness and responsiveness of staff. Patients said that staff explained treatment plans to them in a way that they could easily understand.

Our key findings were:

• The practice had systems in place for investigating and learning from complaints, safety incidents and accidents. Staff were aware of their responsibilities to report incidents.
• The practice was visibly clean and clutter free. Infection control practices were reviewed and audited to test their effectiveness.
• There were systems in place to help keep people safe, including safeguarding vulnerable children and adults. Staff had undertaken training and were aware of their roles and responsibilities in relation to this.
• Risks to the health, welfare and safety of patients and staff were regularly assessed and managed. These included risks in relation to fire, legionella and risks associated with premises and equipment.
• The practice reviewed and followed guidance in relation to dentistry. However we found that dentists did not routinely use a rubber dam as recommended to protect patient’s airways when carrying out root canal treatment.
• The practice had the recommended medicines and equipment for use in the event of a medical emergency and staff were trained in their use. Records were maintained in respect of the checks carried out for these medicines and equipment.
• Staff were supported, supervised and undertook training in respect of their roles and responsibilities within the practice.
• Patients reported that they were treated with respect and that staff were polite and helpful.
• Patients were involved in making decisions about their care and treatments.
• Effective governance arrangements were in place for the smooth running of the service.
• Audits and reviews were carried out to monitor and improve services. Learning from audits and reviews was shared with relevant staff and action plans were developed to secure improvements where these were identified.
• Patient’s views were sought and these were used to make improvements to the service where these were identified.

There was an where the provider could make improvements and should:

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

During our inspection we looked at the records for ten people using the service and spoke with six people including two people with children using the service. Comments regarding the service provided included, "Fantastic", "The service is really good", and "Very good on the phone."

One person commented that it was slightly difficult getting a child's pushchair upstairs but that it was not a big issue. There are surgeries both downstairs and upstairs and ramped accessed so accessibility issues have been considered.

We saw that people are given informed choices and guidance about their treatment. Where a person is anxious then dentists will adapt their approach to accommodate this.

The surgery was clean and tidy. We found that the provider was aware of best practice and areas needing improvement. Staff felt supported and have sufficient training to meet people's needs.

We saw that the atmosphere in the surgery was relaxed and people using the service were positive about their experience. We spoke with a range of people, some who were apprehensive about visiting the dentists and others who had no issue. Parents felt that the dentist and dental nurses approach with children was good and put them at their ease. Children appeared content in the environment and we observed staff interactions with children to be good.

We carried out an unannounced focused inspection on 6 and 15 July 2016 following concerns raised by staff and members of the public.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the aspects of the relevant regulations which we inspected.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the aspects of the relevant regulations which we inspected.

Background

Elder Tree Dental Practice is a dental practice situated in a converted property on Canvey Island, Essex.

The practice has four treatment rooms, two waiting rooms and a reception area. Decontamination takes place within treatment a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

The practice has a principal dentist, three associate dentists and three dental nurses.

The practice offers NHS and private general and cosmetic dental treatments to adults and children.

The opening hours of the practice are 9am to 5.30pm Monday to Thursday. Appointments are available from 9am to 1pm and 2pm to 5.15pm. The practice is open between 9am and 5pm on Fridays and appointments are available up to 4.45pm. The practice closes between 1pm and 2pm for lunch.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

Our key findings from our inspection visit on 6 July were:

• The practice did not have effective systems in place for investigating and learning from safety incidents.
• There was evidence of a cockroach infestation in the staff kitchen area and in the corridors on the first floor.
• The practice had not acted in a timely way to remove the infestation once this had been reported.
• Most areas within the practice were visibly clean and clutter free. However we found that infection control procedures were not followed consistently. The practice did not follow the national colour coding scheme for cleaning materials and equipment in dental premises to ensure that equipment used for cleaning was specific to the area that was being cleaned, and clinical waste was not stored appropriately.
• There were ineffective governance arrangements in place to assess, monitor and manage the safety and quality of services provided.
• Risks to patients and staff had not been assessed, monitored and mitigated in a timely way.
• There was a lack of clear leadership and staff did not feel supported to raise concerns.
• The practice did not act on feedback from patients and staff and use this to make improvements where these were identified.

As a result of our findings the registered provider agreed to close the practice until such time as appropriate measures were taken to remove the cockroach infestation. The practice was closed from 6 July 2016 to 12 July 2016.

Our key findings from our inspection visit on 15 July were:

• A pest control company had carried out treatment to remove the infestation.
• Insect traps were in place and staff told us that there had seen no evidence of infestation activity.
• We inspected these traps and we found no evidence of infestation activity.
• There was no risk assessment, guidance available for staff or arrangements for checking and monitoring infestation activity to demonstrate the effectiveness of the eradication measures in place.

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

• Ensure that there are appropriate systems in place for monitoring the quality and safety of the services provided. This includes listening to and acting on concerns raised by staff or people who use the service and; reviewing, monitoring and improving systems for dealing with any events which may cause unnecessary risk to people.