We carried out a focused inspection of Gestridge Dental Practice on 21 May 2018.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 1 August 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the area(s) where improvement was required.

At the previous comprehensive inspection we found the registered provider was providing effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing safe care in accordance with Regulation 12 ‘safe care and treatment’ or well-led care in accordance with Regulation 17 ‘good governance’ of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Gestridge Dental Practice on our website www.cqc.org.uk.

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

We carried out this announced inspection on 1 August 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.

We told Healthwatch that we were inspecting the practice. They did not provide any information.

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 not 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 not providing well-led care in accordance with the relevant regulations.

Background

Gestridge Dental Practice is in Kingsteignton and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes one dentist, two dental nurses, one receptionist and one medically trained doctor who provides a conscious sedation service to patients on a sessional basis. The practice has one treatment room.

The practice is owned by a company 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 Gestridge Dental Practice was the dentist.

On the day of inspection we collected 50 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the dentist, one dental nurse and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Tuesday 8am – 6pm.
• Wednesday and Thursday 9am – 6pm
• Friday 8am – 2pm.

Our key findings were:

• Staff treated patients with dignity and respect.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• Patient care records were not always completed fully.
• Recruitment records were not complete for all staff.
• Checks and maintenance on equipment used in the practice were not consistently performed.
• Policies informing procedures and practice were not always up to date.
• Policies and procedures for the delivery of conscious sedation were not robust.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For example, in the monitoring of medicines management in the practice.
• Ensure care and treatment is provided in a safe way to patients, in particular when treating patients for conscious sedation, completion of essential recruitment checks for all staff employed and provision of essential training for staff relevant to their roles.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Introduce protocols regarding the prescribing and recording of antibiotic medicines taking into account guidance provided by the Faculty of General Dental Practice in respect of antimicrobial prescribing.

We reviewed all the information we hold about this provider, carried out a visit on 11th September 2012 and checked the provider's records, policies and procedures. We talked to staff and to patients who use the service. We observed treatment which took place.

We spoke with two patients during this visit who were attending for examination or treatment. The feedback was entirely positive. One person said “I’ve always had first class service here.” Another person said “It’s always clean and tidy here and the staff are lovely, really nice”.

We also looked at the comments and suggestions book in the practice and at surveys recently completed by patients who used the service. These showed a high degree of satisfaction with the service. One patient said “I am a very fussy patient and everything was 100% to my satisfaction”. Another patient said ““The dentist and all staff are very kind and good and I would not let anyone else touch my teeth.”

We saw the practice was well maintained and that the treatment and reception rooms were clean. Staff we spoke with had a good understanding of infection control procedures and were following guidance appropriately.

One dentist provides treatment at the practice, with one dental nurse and one receptionist. The dentist did not provide NHS care. The practice is located on the ground floor with level access throughout.