We carried out an announced comprehensive inspection on 24 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

Gibraltar House Dental Clinic is an NHS dental practice which provides general dentistry and also specialises in providing complex treatment for patients such as oral surgery and for nervous patients including those with significant anxieties about having dental treatment. The practice caters for children and adults.

The practice has four dental treatment rooms and two decontamination rooms for cleaning, sterilising and packaging of dental instruments. There is a reception area and waiting room on the ground floor and another waiting area upstairs on the first floor.

The practice has seven dentists and eleven dental nurses. Two dental hygienists provide preventative advice and gum treatments on prescription from the dentists working in the practice. The practice also uses specialist input from three anaesthetists (one adult and two paediatric).

The practice manager and clinical team are supported by an administrator and four receptionists.

The provider is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to use to tell us about their experience of the practice. We collected 22 completed cards. These provided a positive view of the service the practice provides. We also spoke with five patients. Patients were complimentary about the friendliness and professionalism of staff, the care and treatment they received and the standards of cleanliness at the practice. One comment stated that the service was very good but sometimes it was difficult to get an appointment.

Our key findings were:

• Staff reported incidents and kept records of these which the practice used for shared learning.

• The practice was visibly clean and well maintained.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• The practice had effective safeguarding processes and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.

• The practice specialised in supporting nervous patients to overcome their anxieties about having dental treatment. Patients were particularly appreciative of the care and understanding they were shown.

• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD). 
• The practice provided the option of sedation to patients and carried this out in line with guidelines from the Society for the Advancement of Anaesthesia in Dentistry (SAAD)
• The practice had a written sedation and discharge protocol which was followed by staff.

• The practice took into account any comments, concerns or complaints and used these to help them improve the practice.

There was evidence that learning from incidents/investigations took place and appropriate changes were implemented and the provider took account of complaints and comments to improve the service.

We asked two patients who used the service if they knew what to do if they wanted to make a complaint and they told us "I know what to do. I have no complaints to make. If I had a problem, I would speak to the receptionist first, then to the practice manager if not resolved". People told us that they had no concerns at this time.

People told us that they were given clear information about the treatment choices available to them, so that they could come to a decision about which treatment would be best for them. They said that the dentist listened to and respected their wishes with regards to their treatment. One person said, "I was reassured before treatment commenced due to my phobia with dentists and I was pleasantly surprised that I was kept informed of procedure"; another person told us, “They give me options regards my treatment and I choose myself".

All of the patients with whom we spoke gave us positive feedback about the clinic. One of them said, "I'm very pleased with the dental care I get. I think it's excellent. , “All my life I have been avoiding dentists but I am now comfortable here",

We saw that incidents and accidents reports were completed. There was no system to ensure that learning from any incidents/investigations would take place so that appropriate changes could be implemented.

People told us that if they had any concerns they would talk to the practice manager or the dentist. However, the displayed procedure did not include what to do if a person was not satisfied with how the practice had handled their compliant. Nor did it advise patients on how to make a complaint directly to another agency if the complaint was of a serious nature.

The clinic had a number of systems in place to make sure that the service assessed and monitored its delivery of care.