We carried out an announced comprehensive inspection on 19 July 2016 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

Greenleaves Dental Practice is a general dental practice situated in the town of Potters Bar, Hertfordshire. It provides general dentistry to adults and children funded by the NHS or privately. They also offer the placement of implants (where a metal post is placed surgically into the jaw bone to support a tooth or teeth) and offer treatment under conscious sedation (these are techniques in which the use of a medicine or medicines produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation).

The practice is situated on the high street in Potters Bar with good public transport links, and free car parking a short walk from the practice.

The practice is open from 8 am to 7 pm on Monday and Tuesday, 8 am to 6 pm on Wednesday and Thursday, 8 am to 5pm on Friday and 8 am to 3 pm on a Saturday.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, 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.

Prior to our visit we left comment cards at the practice which we collected on the day of the inspection. 28 patients provided feedback about the service in this way. Patients reported very positively about the service.

Our key findings were:

• The practice was visibly clean and clutter free.

• Patients reported positive experiences at the practice and commented that they were treated with care and understanding.

• The practice could normally arrange a routine appointment within one to two days and emergency appointments mostly on the same day.

• The practice offered evening and Saturday appointments to allow flexibility for those with commitments during normal working hours.

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.

• The practice had all the emergency equipment recommended by the Resuscitation Council UK for use in a medical emergency, and all emergency medicines as recommended in the British National Formulary.

• The clinicians used nationally recognised guidelines in the care and treatment of patients.

• X-ray machines, although serviced, had not been tested for dose within the recommended three years, although this was arranged shortly following the inspection.

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

• Establish whether the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.

• Review the practice’s protocols for conscious sedation, giving due regard to 2015 guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

• Review the practice's recruitment policy and procedures to ensure character references for new staff as well as proof of identification are requested and recorded suitably.

• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development.

• Review the practice’s audit protocols for completion of infection control audits at regular intervals to help improve the quality of service. Practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

• Review the procedures to track referrals made to other services, and ensure that this is used consistently.

We inspected Greenleaves Dental practice on 11 December 2013, we found the practice to be visibly clean and the reception area provided areas of people to sit and read material about the treatments available in the practice. We saw that the reception staff was curtious and happy to assist people as they entered the practice.

When we spoke to people who used the service they told us that the practice was 'very good' and they had recommended it to friends and family. We were told that the dentist was 'better and quicker' then any other dentist they had seen and the treatment was virtually 'painless'. They told us that the dentists 'explained everything' and 'made you feel at ease' when providing treatment.

We found that the provider was meeting the regulations that we inspected but due to them recently setting up a second practice, the provider had not kept up to date with the reviewing of risk assessments which was putting people at risk. Infection control procedures were in place and staff at the service had received the training required for their roles. Checks had been carried out prior to employment. The provider had a robust complaints procedure in place and acted on any complaint that was received.