We carried out an announced comprehensive inspection on 9 December 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Hathaway Dental Practice is a dental practice providing NHS and private treatment for both adults and children. The practice is situated in a purpose build medical centre with whom it shares some responsibilities for the building. The practice had six dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments. Dental care was provided on the first floor of the building with lift access to the practice reception, waiting areas and treatment rooms.

The practice is open Monday 8.30am – 7.00pm, Tuesday and Wednesday 8.30am – 5.00pm Thursday, 8.30am – 6.30pm, Friday 8.00am – 4.00pm. The practice is also open on Saturdays 9.00am – 2.00pm. The practice has seven dentists who are supported by 10 dental nurses, seven of whom are trainees, two dental hygienists and four reception staff.

Fees are displayed in information leaflets for patients available in the practice and NHS fees are displayed on the practice website. There are arrangements in place to ensure patients receive urgent dental assistance when the practice is closed. This is provided by an out-of-hours service which can be accessed by calling NHS 111. These arrangements are displayed in the practice and on a telephone answering service.

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. The registered manager is also one of the three trained dental nurses in the practice.

Before the inspection, we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from nine patients. In addition we spoke with three patients on the day of our inspection. Feedback from patients was positive about the quality of care, the caring nature of all staff and the overall high quality of customer care. They commented that staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained them so they could make an informed decision which gave them confidence in the care provided.

Our key findings were:

• We observed and were told by staff the practice ethos provided patient centred dental care in a relaxed and friendly environment.
• Leadership was provided by an empowered practice manager.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• Premises appeared well maintained and visibly clean. Good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation.

• There were systems in place to check all equipment had been serviced regularly, including the autoclaves and the X-ray equipment.

• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Infection control procedures were comprehensive and the practice followed published guidance.
• The practice had a safeguarding lead with effective processes in place for safeguarding children and adults and living in vulnerable circumstances.
• There was a process in place for the reporting of untoward incidents that occurred in the practice.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• Dentists used Loups – these enable the clinician to have a magnified view of the operation site thus enabling accuracy of treatment.

• Digital radiographs were used to help explain necessary treatment to patients while in the chair.

• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.

• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required including Saturday mornings.
• Staff received training appropriate to their roles and were supported in their continuing professional development (CPD) by the company.
• Staff we spoke with felt well supported by the practice manager and were committed to providing a quality service to their patients.
• Information from nine completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.

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

• Review the systems to meet health and safety regulations with respect to fire; including the practice fire risk assessment.

• Review the storage arrangements for clinical waste prior to collection by the waste management contractor.

• Review the refrigerated storage arrangements for the relevant emergency medicine.

• Review providing the dental hygienist with the support of an appropriately trained member of the dental team at all times.

• Review the frequency of staff meetings to ensure that all staff have an opportunity to take part in shared learning and provide feedback at least monthly.

• Review and consider providing an annual statement in relation to infection prevention control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.

• Review the system for the recording of staff training.

• Review the practice recruitment policy and procedures to ensure the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Review staff awareness of Gillick competency and ensure all staff is aware of their responsibilities.

• Review the arrangements for the availability of additional oxygen in a medical emergency.

During our visit to Hathaway Dental Practice we met with the registered manager and spoke with four members of staff. We spoke with five patients and looked at three sets of patient records.

All of the patients we spoke with were very happy with the dental treatment they received. One said “it’s an excellent practice. My whole family come here. Staff are friendly and I’ve never had to wait too long. They always talk through the problem and treatment options”. Another said “the dentist has given me top tips for brushing and this has improved my oral health”.

Patients said they were involved in their treatment plans and their permission was sought before any treatment commenced. We saw patients had a treatment plan which they signed as consent to the treatment and costs.

Patients we spoke with told us the practice was always clean and tidy, one said “the cleanliness is exceptional. Everything is totally in order every time I have been here. The surfaces in the surgery are visibly wiped before each patient”. We found current infection control guidelines were followed to reduce the risk of infection.

Staff told us they were supported to carry out their roles. We saw staff received training specific to their job and received a regular appraisal.

The practice had systems in place to seek regular feedback from patients to enable them to improve the service it offered. The practice had carried out audits to monitor clinical quality and improve the service.

We spoke with six people who used the service. People told us they chose the practice for various reasons, some because their GP was in the same medical centre and others because NHS treatment was available there.

Some of the people were waiting for treatment and told us their dentist explained the procedure to them in advance so they knew what to expect. People told us they were happy with the service they received with one person stating “I am really happy here” it is “one of the best practices I’ve been to”. Another person said “the service is good and the dentist is ‘second to none” adding “it’s first class”.

People told us about the text messages they received on their mobile telephones to remind them about forthcoming appointments and how they appreciated this. They complimented the reception staff and spoke about how clean they found the premises to be.