We carried out this announced inspection on 10 January 2018 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

Grafton House Dental Surgery (also known as Active Smile) is situated in Evesham town centre, Worcestershire. It provides predominantly NHS treatments to patients of all ages with private treatment options available.

There is level access for people who use wheelchairs and pushchairs. The ground floor of the practice consists of a reception area, a waiting room, an accessible patient toilet and two dental treatment rooms. On the first floor there is a panoral X-ray room, a patient toilet, four dental treatment rooms and a patient waiting area. On the second floor there is a further dental treatment room, a staff room / kitchen, a patient toilet and a decontamination room for the cleaning, sterilising and packing of dental instruments. In addition to this, the ground floor of the building next door is also used by the practice and contains an information centre, an office, staff toilet, staff kitchen area and a stock room. There are car parking spaces for blue badge holders directly outside the practice and pay and display car parks are available a short walk from the practice.

The dental team includes five dentists, a visiting implantologist, and nine dental nurses including two trainee dental nurse (most of whom also work as receptionists and two who in addition work as treatment care co-ordinators), three dental hygienists, an operations manager, a business manager and a practice manager. The practice has seven dental treatment rooms.

The practice is owned by an individual who is the business manager there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 31 CQC comment cards filled in by patients and looked at results from recent patient suggestions and practice patient satisfaction surveys. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, two dental nurses, two dental hygienists, one receptionist, the business manager 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 8.30 am – 6 pm

Tuesday 7.30 am – 4.45 pm

Wednesday 8.30 am – 6 pm

Thursday 8.30 am – 7 pm

Friday 8.30 am – 4 pm

Saturday 9am – 1pm

Our key findings were:

• The practice was clean and well maintained.
• 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.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD) by the business manager and practice manager. We found that not all staff had a full understanding of the Mental Capacity Act (MCA) 2005 and the practice manager had scheduled training in March 2018 to rectify this.
• The practice had systems to help them manage risk. The practice had completed a fire risk assessment and were in the process of completing the required actions such as installing an alarm system.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Contact details for the local authority safeguarding team were displayed in the staff room.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Dental care records provided comprehensive information about patients care and treatment.
• 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 routine treatment and urgent and emergency care when required.
• The practice had effective leadership. Staff we spoke with felt well supported by the lead dentist, the business manager and practice manager and were committed to providing a quality service to their patients.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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

• Review the management of prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's fire risk assessment ensuring all the necessary actions are implemented.