We carried out an announced comprehensive inspection on 29 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

Handforth Dental Practice LLP is located in the centre of Handforth. It comprises a reception and waiting room, four treatment rooms and patient toilet facilities all on the first floor. Parking is available near the practice. The practice is accessible to patients with disabilities and limited mobility, but not to wheelchair users. The practice can be accessed by patients with limited mobility but only via a flight of stairs.

Closed circuit television monitoring is in place at the premises internally in the reception, waiting room and corridor leading to the treatment rooms.

The practice provides general dental treatment to patients of all ages on an NHS or privately funded basis. The opening times are Monday, Wednesday, Thursday 9.00am to 5.30pm, Tuesday 7.45am to 7.00pm and Friday 7.45am to 5.30pm. The practice is staffed by a principal dentist, a practice manager, five associate dentists, a dental hygienist, four dental nurses, and two receptionists.

The practice manager 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.

We received feedback from 33 people during the inspection about the services provided. Patients commented that they found the practice excellent, and that staff were professional, friendly, and caring. They said the dentists listened carefully to them and they were always given good, honest explanations about dental treatment. Several patients commented that the practice environment had improved greatly with the recent re-furbishment and provided clean, comfortable surroundings.

Our key findings were:

• The practice had procedures in place to record, analyse and learn from significant events and incidents.
• Staff knew the processes to follow to raise concerns.
• Staff had been trained to deal with medical emergencies, and emergency medicines and equipment were available.
• The premises and equipment were clean, secure and well maintained.
• Staff followed current infection control guidelines for decontaminating and sterilising instruments.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current standards and guidance.
• Patients received information about their care, proposed treatment, costs, benefits, and risks and were involved in making decisions about it.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• Patients were treated with kindness, dignity, and respect, and their confidentiality was maintained.
• The appointment system met the needs of patients, and emergency appointments were available.
• Services were planned and delivered to meet the needs of patients.
• The practice gathered and took account of the views of patients.
• Staff were supervised, felt involved, and worked together as a team.
• Governance arrangements were in place for the running of the practice, but some improvements were needed to recruitment and training processes and the management of risk.

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

• Review the system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities, specifically in relation to risks to staff carrying out clinical duties where the effectiveness of the Hepatitis B vaccination is unknown.
• Review the practice’s recruitment procedures for maintaining accurate, complete and detailed records relating to the employment of staff, including locum staff, in compliance with the Regulations.
• Review the training, learning and development needs of staff to ensure they are up to date with their continuing professional development, specifically in relation to Legionella awareness training, and consent, including the Mental Capacity Act and Gillick competence.
• Review the practice’s protocols in relation to the use of closed circuit television to ensure staff and patients are fully informed as to its purpose and their right to access footage.
• Review the complaints procedure to ensure details of alternative organisations to which patients can complain are readily available.

During our previous inspection on 23 July 2013, we had some concerns that that the provider did not have effective recruitment and selection procedures in place. Following that inspection the service had sent us an action plan detailing the improvements they were going to make.

During this inspection we looked at the new policies and procedures which had been implemented and saw a sample of staff files. We saw that significant improvements had been made and they now had safe and effective recruitment and selection procedures in place.

We spoke with three people who were visiting the practice during our inspection. People were complimentary about the service they received. Some of the comments we received were “The staff are absolutely marvellous, I can’t speak highly enough of them,” “The staff are lovely, friendly and professional,” “I am very pleased with the practice, I come a long way” and “I never worry about coming because of the way they are with you.”

We were told that treatment options were discussed with people and that included the price of treatments.

We were told that people had their privacy and dignity respected. When asked about one person said “They certainly do its 10 out of 10.”

We looked at the cleanliness of the practice and the safety processes that they had in place to protect the health of their patients. People told us that the dental practice was well presented and that the surgeries were always clean and tidy when they attended.

We looked at their complaints procedure and found that it was clear and was available for people to access.

We had some concerns that the provider did not have effective recruitment and selection procedures in place.