We carried out an announced comprehensive inspection on 17th 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

Green Park Dental Practice is located in the Green park area of Bath and provides private and NHS treatment to patients of all ages. The practice consists of two treatment rooms, one for the dentist and one for the hygienist. There are also two treatment rooms used by two other dental providers.The premises has toilet facilities for patients and staff, a reception/ waiting area and a staff room.

The practice treats both adults and children.The practice offers routine examinations and treatment. It is run by one dentist who is also the registered provider. A registered provider is a person who is registered with the Care Quality Commission and has a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

The practice’s opening hours are

8.00am to 1.00pm and 2.00pm to 4.45pm on Monday to Thursday

8.00am to 1.00pm and 2.00pm to 4.00pm on Fridays.

There is a dentist oncall during evenings and weekends in case of an emergency.

We carried out an announced, comprehensive inspection on 17th November 2015. The inspection was led by a CQC inspector. They were accompanied by a dentist specialist advisor.

Before the inspection we looked at the NHS Choices website. In the previous year there had been one positive comment about the practice.

For this inspection 25 people provided feedback to us about the service. Patients were positive about the care they received from the practice. They were complimentary about the service offered which was good and excellent. They told us that staff were kind, caring, sympathetic and professional. Patients told us that they were listened to, staff treated them with dignity and respect and the practice was clean and hygienic. We received no negative comments.

Our key findings were:

• Safe systems and processes were in place, including a lead for safeguarding and infection control.

• Staff recruitment policies were appropriate and relevant checks were completed. Staff received relevant training.

• The practice had ensured that risk assessments were in place and that they were regularly reviewed.

• The clinical equipment in the practice was appropriately maintained. The practice appeared visibly clean throughout.

• The practice maintained appropriate dental care records and patients’ clinical details were updated suitably.

• Patients were provided with health promotion advice to promote good oral care.

• Patients gave consent to treatment and they were given treatment plans.

• Staff were aware of what process to follow when a person lacked capacity to give consent to treatment.

• All feedback that we received from patients was positive; they stated that it was a caring and effective service.

• There were governance systems, for example auditing of infection control, medical histories and radiographs.

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

• Review the decontamination process and introduce the changing of heavy duty rubber gloves before examination of instruments to prevent recontamination of instruments after washing.
• Consider the use of disposable protective barriers on surfaces in the surgeries, that are frequently touched by the dentist to provide an additional level of protection for patients from the risk of infection.
• Obtain information about local translation services in case someone needs an independent translator.

This inspection was carried out to follow up on three compliance actions issued at the last inspection on 17 June 2014.

The practice needed to improve how they monitored the service to ensure patient views were taken into account and acted upon to improve the service provided.

The practice was not following the guidance about decontamination of instruments to reduce the risk of infection.

The practice was not making sure that staff had appropriate CPD (Continual Professional Development) and was not making sure that staff were supported through supervision and appraisal.

The provider sent us an action plan showing how they would address these issues by October 2014.

At this inspection we spoke with two people who use the service. They all spoke highly of the service that they received from the dentist. One said that they had been very nervous about coming to the dentist but this dentist had put them at their ease and they felt comfortable to visit the dentist. The other person said that their relative had been very nervous but the dentist put them at their ease. Both people knew how to make a complaint and felt comfortable to complain.

We found on this inspection that the provider had introduced a survey to collect the views of people through questionnaires available in reception. They had also had a survey completed by dental plan company and had just received the findings. They planned to discuss the survey at their next team meeting to develop an action plan and make any improvements needed.

Some changes had been made to the decontamination procedure by the introduction of a new detergent for washing instruments. Staff were wearing personal protective equipment when decontaminating instruments. Cleaning equipment for clinical and non-clinical areas was being stored separately. However, the practice was still not following guidance about decontamination of instruments to reduce the risk of infection.

A Legionella risk assessment had been conducted in August 2014 and action had been taken to reduce the risk of infection by Legionella. An audit of waste segregation was conducted in July 2014 and clinical waste was being kept separate from ordinary waste to reduce the risk of cross contamination. An audit of the infection control procedures had been conducted in July 2014 and there was a plan to audit infection control every six months. Some improvements had been made following the audit but the audit was not effective because it did not identify that there were problems with the decontamination process.

We found that staff had opportunities for continual professional development (CPD.) The practice had started to monitor their requirements for CPD. A system for appraisal and supervision for staff had been introduced to support them in their CPD.

During our visit to Green Park Dental Practice we met with the provider and spoke with six members of staff. We spoke with six patients from Green Park Dental Practice, two of whom were patients of Mr Smillie, the provider. We looked at two sets of patient records. Green Park Dental Practice was shared by three dental providers [dentists] registered in their own right. The three providers shared responsibility for some resources, for example, the hygienist, administrative staff and communal areas of the building, whilst maintaining individually responsibility for others, for example their dental nurses, their clinical audit and their surgeries.

Both of the patients we spoke with were very happy with the dental treatment they received. One said “he draws diagrams and explains every little thing he’s going to do. I’ve never known a dentist like it. It’s really good”. Another told us they had moved with the dentist when the practice moved location because they were “so good”.

Patients we spoke with told us the practice was always clean and tidy, one said “it’s immaculate”. We found, however, current infection control guidelines were not always followed.

Staff told us they were informally supported to carry out their roles. We saw staff received training specific to their job. However, staff had not received an annual review of their performance in line with the practice’s own policy.

The practice did not have a system in place to seek regular feedback from all patient groups (NHS and private) to enable the practice to improve the service it offered. The practice had carried out audits to monitor clinical quality and improve the service. However, there were no clear systems in place to demonstrate how the quality of the service would be monitored and improved.

We were able to speak with three people using the services of the practice during our inspection visit.

Comments people told us when talking about the dentist were; “excellent service. I have been coming to see Mr Smillie for a number of years. When he changed practices I followed him as I did not want to lose him as my dentist”

The people who received treatment told us they felt they were fully involved in decisions about their treatments. They said the reason they needed it was clearly explained to them using X-rays and a camera. They told us that alternative treatments were discussed with them and they received written plans with details of their treatment and its costs. They said that they were asked about their medical histories and were given advice about oral health and hygiene.

All the people we spoke with told us that making appointments was easy. They were complimentary about the staff working in the practice and said they felt they were treated with respect.