We carried out an announced comprehensive inspection on 11 August 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

Highfields Dental Practice is located in a residential suburb close to the centre of Crewe. It comprises a reception and waiting room on the ground floor and a treatment room, a further waiting room, offices, storage and staff rooms on the upper floors. Parking is available on nearby streets. The premises is accessible to patients with disabilities, impaired mobility and to wheelchair users but the treatment room is on the first floor accessed by a flight of stairs.

The practice provides general dental treatment to patients on an NHS or privately funded basis. The opening times are Monday to Friday 8.30am to 5.30pm. The practice is staffed by a principal dentist, a practice manager, four dental nurses, one of whom is a trainee, and a receptionist.

The principal dentist is registered with the Care Quality Commission as an individual. 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 location is shared with another separately registered dental service provider.

We received feedback from seven people during the inspection about the services provided. Patients commented that the staff were friendly and helpful and that the service was very good.

Our key findings were:

• Staff had received safeguarding training and knew the process to follow to raise concerns.
• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies, and emergency medicines and equipment were available.
• The premises and equipment were clean and secure.
• Infection control procedures were in place and the practice followed current guidelines.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current legislation, 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 and reasonable adjustments were made to enable patients to receive their care and treatment.
• Staff were supervised, felt involved and worked as a team.
• Governance arrangements were in place for the smooth running of the practice.
• The practice had procedures in place to record and analyse significant events and incidents; however not all significant events were recorded.
• The practice gathered the views of patients but we did not see evidence of patient feedback being taken into account.

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

• Review the practice’s infection control procedures and protocols, specifically in relation to cleaning equipment storage, to ensure they are suitable, having due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review the practice’s audit protocols to ensure that all audits have documented learning points and the resulting improvements can be demonstrated as part of the audit process.
• Review the systems in place to assess, monitor and improve the quality and safety of the service provided, specifically in relation to the recording of all significant events, and acting on patient feedback.
• Review the communication processes to ensure effective communication and forward planning are enabled with the other provider who shares this location. This should include, for example, the implementation of an agreement or protocol in relation to shared services.

When we carried out our inspection we spoke to two patients of the provider. They told us that they gave consent to treatment and that the dentist discussed treatment with them.

Both patients were satisfied with the service and one said they had “a very good dentist”. However some concerns were raised about the punctuality of appointments.

We found that the premises including the surgeries were clean and that the practice had appropriate procedures for infection prevention and control. Reusable instruments were decontaminated properly in suitable decontamination rooms and both staff and patients used personal protective equipment when appropriate.

Equipment including x-ray machines was serviced properly.

There was an effective complaints process and the provider a variety of other methods to collect comments from their patients.