We carried out an announced comprehensive inspection on 9 November 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

Ethos dental care is located on the main road into Stockport and provides predominantly (60%) NHS dental treatment and a smaller amount (40%) of private treatment.

The practice opening hours are Monday 9am until 5pm, Tuesday and Thursday 9am until 5.30pm, Wednesday 9am until 6pm and Friday 8am until 2pm. Appointments are available on Saturday mornings by appointment.

The treatment rooms were located on the ground and first floors and both floors have a dedicated decontamination room. The practice has a principal dentist (who is also the owner) and four associate dentists who offer a range of specialist services such as conscious sedation, implants, orthodontics and endodontics. The practice also has a dental hygienist/therapist, four registered dental nurses, two trainee dental nurses and a receptionist.

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.

The inspection took place over one day and was carried out by a CQC inspector and dental specialist advisor.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice.

Our key findings were:

• Staff had a good understanding of patient confidentiality and we observed good interactions between staff and patients.

• Staff had received essential training and were supported in their continued professional development (CPD).

• There were systems in place to reduce the risk and spread of infection. We found all treatment rooms were visibly clean and clutter free.

• There were processes in place for patients to feedback about the service.

• There was a complaints policy and procedure in place that was available to patients.

• The practice had systems and processes in place to ensure patients were protected from abuse and avoidable harm. Staff showed a good understanding of the different types of abuse and how to identify the signs.

• The practice followed recognised and approved national guidance such as the National Institute for Health and Care Excellence (NICE).

• Emergency appointment slots were available and patients were seen the same day if they had a dental emergency.

• Different treatment options were discussed with patients to enable them to make informed decisions.

• The practice had the appropriate equipment and medicines to deal with medical emergencies. Staff knew where to access the equipment and had received training in responding to a medical emergency.

• There were procedures for the safe management, storage and disposal of clinical waste.

• This practice offered conscious sedation to patients, however dental nurses assisting the dentist with conscious sedation had not received appropriate training. The principal dentist made arrangements to secure this training during the inspection.

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

• Keep a daily record of the temperature of the refrigerator used to store medicines.
• Ensure the COSHH file contains information about all of the substances in use in the practice and include risk assessments.
• Remove the mops and buckets from the decontamination room on the ground floor.
• Review and where required update policies and procedures.
• Maintain accurate, complete and detailed records relating to employment of staff. This includes keeping appropriate records of references taken.
• Review the system of stock checks to ensure that out-of-date products are disposed of in a timely manner.

• 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.