We carried out an announced comprehensive inspection on 13 March 2017 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

Glenfield Dental is a dental practice providing NHS care and private care for adults and children. Where private treatment is provided some is under a fee per item basis and some under a dental insurance plan. The practice is situated in a converted property and has six dental treatment rooms; two on the ground floor and four on the first floor. There is a reception and waiting area on the ground floor and a reception and waiting room on the first floor. There were also other rooms used by the practice for office facilities and storage. The practice is open from 9.00am to 5.30pm Monday to Friday and from 9.00am to 1.00pm on Saturdays by appointment.

The practice has three full time dentists, one of them being the principal dentist and two further part time dentists. They are supported by a part time dental therapist, three part time dental hygienists, seven dental nurses, three trainee dental nurses, a practice manager, five receptionists and an administrator.

The practice is able to provide general dental services including endodontic (root canal) treatment, orthodontic treatment, implants and cosmetic dentistry. The practice also provides the option of treatment under conscious sedation and the expected arrangements are in place to do this safely. Conscious sedation is the use of medicines to reduce alertness and help the patient relax but still be able to hear and respond to the dentist if necessary, while treatment is carried out. The practice also carries out a small number of domiciliary visits.

The principal dentist is registered with the Care Quality Commission as an individual. Registered persons have a 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 complete to tell us about their experience. We received feedback from a total of 47 patients. All feedback was positive with patients commenting favourably on the quality of care and service they received, the professional, kind, helpful and caring nature of staff and the cleanliness of the practice.

Our key findings were:

• Staff reported incidents which were investigated, discussed and learning implemented to improve safety.
• The practice was visibly clean and well maintained and infection control procedures were in line with the requirements of the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices’ published by the Department of Health. However we found that the large external clinical waste bin used by the practice was locked but not secured to the wall and sharps bins were not replaced after three months in line with national guidance. Following our inspection the practice manager told us these issues were being addressed.
• The practice had medicines and equipment for use in a medical emergency which were stored securely and were in accordance with national guidelines. However two items were not available in the correct dose and the glucagon did not have the correct expiry date. These issues were rectified during or immediately after our inspection.
• Use of X-rays on the premises was in line with the Regulations.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).
• Patients commented that they were extremely pleased with the care they received and that staff were helpful, caring, considerate and polite.
• The practice had suitable facilities and was equipped to treat patients and meet their needs.

• Governance arrangements were in place for the smooth running of the practice. The practice carried out a range of audits, however not all audits had documented learning points or associated action plans.

• The practice undertook a small number of domiciliary visits and not all appropriate protocols were in place to ensure the visits were carried out in line with national guidance. Following our inspection, the practice manager informed us that they had started to implement the appropriate protocols and were reviewing their provision of domiciliary services.

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

• Review its audit protocols to document learning points that are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.
• Review the practice’s protocols for domiciliary visits to ensure they are suitable giving due regard to national guidance.
• Review the practice’s waste handling policy and procedure to ensure clinical waste is stored securely prior to collection and sharps bins are replaced in accordance with relevant regulations and giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).

We spoke with five patients and six members of staff. We reviewed five treatment records and plans. We saw information relating to nine members of staff.

The patients we spoke with told us that their treatment had been discussed and that they were able to make an informed decision about their treatment. One patient told us: “It’s very nice. It’s easy to get an appointment. I am always given an explanation and choices, before I consent to the treatment. I usually sign to consent.”

All of the patients we spoke with had high regard for the quality of care and kindness displayed by the staff. One patient told us: “I am happy with the dentist, they know me well. They are always very polite, very nice and very good. I have no complaints whatsoever.” Another patient told us: “It’s easy to get an appointment. The staff are friendly, welcoming and smiling. It’s always been a good dentist, very professional. I have always found it good and have no complaints at all.”

Staff were observed wearing uniforms and other appropriate personal protective equipment. None of the patients we spoke with had any concerns about the cleanliness of the practice.

We saw that all dental treatment was provided by a qualified dentist and the dental nurses who were registered with the General Dental Council (GDC), the professional regulator of dental practitioners.

We saw a range of audits, risk assessments and checks were carried out to ensure systems and practices were working effectively.