We carried out this announced inspection on 24 October 2017 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

Evesham Dental Health Team is located in Evesham and provides predominantly private treatment with a small NHS contract to patients of all ages.

The practice is situated in a converted residential building which has been extended to provide additional facilities for patients. The building is spread over three floors with an adjoining annexe and there is level access into the practice for people who use wheelchairs and pushchairs. The ground floor of the practice consists of a front reception with patient seating area, a back reception, two patient toilets, two dental treatment rooms, two stock rooms, a staff changing room and a staff kitchen. On the first floor there is an x-ray room, three hygiene treatment rooms, one dental treatment room, a consultation room, a patient toilet and a decontamination room for the cleaning, sterilising and packing of dental instruments. The second floor is not accessible to patients and contains a dental laboratory and additional storage. The adjoining annexe houses the practice management office and further staff changing facilities. The practice benefits from five car parking spaces in their dedicated car park, they have a reserved for disabled access sign that they use to ensure that patients requiring the larger car parking space have access.

The dental team includes three dentists, 11 dental nurses, two dental hygiene therapists, two dental hygienists, three care coordinators and a practice manager. The practice has six treatment rooms in total.

The practice is owned by the principal dentist and his wife who is the practice manager there 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 manager at Evesham Dental Health Team is the practice manager.

On the day of inspection we collected 41 CQC comment cards filled in by patients and received 18 ‘share your experience’ contacts through the CQC database. This information gave us an extremely positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses, one dental hygiene therapist, one care coordinator and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday: 8.30am – 7pm

Tuesday: 8.30am – 7pm

Wednesday: 8.30am – 7pm

Thursday: 8.30am – 7pm

Friday: 8.30am – 5.30pm

Three out of four Saturdays: 8am – 1pm

Our key findings were:

• We noted that the practice ethos was to provide quality dental care in an environment that was supportive, friendly and relaxed.
• Strong and effective leadership was provided by the principal dentist and empowered practice manager. Staff felt involved and supported and worked well as a team.
• Staff had received training appropriate to their roles and were supported in their continued professional development by the principal dentist and practice manager.
• The practice was clean and well maintained. Contracted cleaners were responsible for the day to day cleaning.
• The practice had infection control procedures which reflected published guidance.
• 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 had an established process for reporting and recording significant events and accidents to ensure they investigated these and took remedial action.
• The practice 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 and took care to protect their privacy and personal information.
• The appointment system met patients’ needs. Patients could access treatment and urgent and emergency care when required.
• The practice asked staff and patients for feedback about the services they provided. Information from 41 completed Care Quality Commission (CQC) comment cards and 18 ‘share your experience’ patient contacts on the CQC database gave us an extremely positive picture of a professional, friendly, caring and high quality service.
• The practice dealt with complaints positively and efficiently.

We identified an area of notable practice.

• The practice were dedicated to protecting patients from oral cancer and had purchased equipment that could identify abnormal cells often pertaining to oral cancer. All patients were screened using this equipment at every six monthly assessment appointment. If there was a change in the cells patients were then recalled for a retest at a set period of time and then referred to secondary care if appropriate. In addition to this the practice advertised in the local GP practices and pharmacies that this service was free for any local person who wished to be screened as a commitment to minimising late diagnosis of oral cancer in the local area and saving lives.

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

• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the use of risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities ensuring these are reviewed annually.

As part of our inspection we spoke with three people who were registered with the practice. We also spoke with the dentist, the practice manager and the dental nurse. We reviewed six dental records, looked at three staff files, policies and procedures and the complaints log.

People who used the practice told us that they were happy with the quality of treatment they received. They felt they were given enough information about their treatment options and were able to ask any questions that they wanted to.

People told us that the practice was clean and tidy and that they had no concerns about hygiene. The staff told us that regular infection control checks ensured that hygiene and cleanliness was maintained in clinical areas.

By looking through the staff records we were able to see that the dentists and staff were qualified and maintained their continuous professional development (CPD) as required by the General Dental Council (GDC).

Staff told us they felt they were supported by their managers through regular staff meetings and supervisions. The staff said that this helped them make sure their training and developmant needs were identified and addressed.

People were given information about how to complain and time was taken by the provider to ensure that all people who received treatment understood how to complain. There was a complaints system in place that meant that peoples' concerns or complaints were responded to and dealt with efficiently.