We carried out an announced comprehensive inspection on 8 July 2015 as part of our national programme of comprehensive inspections.

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 not providing well-led care in accordance with the relevant regulations.

Background

We carried out an announced comprehensive inspection on 8 July 2015 as part of our national programme of comprehensive inspections.

Hilsea Dental Care provides both private and NHS treatment to patients of all ages. The practice is part of the corporate provider brand Southern Dental Limited. The practice provides general dental services and refers patients to other locations for specialist services such as implants. The practice team consists of two dentists, a dental hygienist, a practice manager, four dental nurses and a receptionist.

The practice is on the ground floor of a converted residential property. There are three treatment rooms, a dedicated decontamination area and a central waiting area.

During our inspection we spoke with patients and reviewed comments cards, which patients had completed in the two weeks before our visit. Patients commented positively about the care they received and the pleasant and friendly manner of the staff.

Our key findings were:

• All staff were kind and caring in the way that they treated patients.
• Patients were able to make routine and emergency appointments and patients were seen the same day if they had a dental emergency.
• The practice had effective systems in place to ensure the decontamination of equipment.

There were areas were the provider must make improvements

• Ensure that dental care records are stored securely in order to protect the confidentiality of patients.
• Ensure there are appropriate risk assessments in place and these are used to inform action plans to minimise (or mitigate) any risks to patients and/or staff.
• Ensure that maintenance checks such as electrical safety tests, fire alarm checks and compressor maintenance checks are completed and ensure that safe systems are in place to manage and monitor the completion of safety checks.
• Ensure that provider governance systems are implemented to manage and monitor the service provision and identify areas where regulations and guidance are not being met.
• Ensure that adequate security is in place at the rear of the building, including security of the hazardous waste bins and dental compressor.
• Ensure the provider’s registration with the care quality commission accurately reflects the current arrangements for the day to day management of the regulated activities.
• Provide staff with all relevant information about their role and ensure that all staff receive regular supervisions and appraisals

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

• Ensure there is a member of staff trained in first aid available at all times.
• Introduce regular staff meetings, keeping a record of the discussions that take place at each meeting.
• Consistently monitor and record refrigerator temperatures to ensure that impressions and medicines are stored at the required temperature.
• Consistently monitor and record checks completed as part of the management of legionella.
• Secure yellow bins at the outside of the building so that they cannot be removed.
• Ensure that consumable items remain in packaging to prevent contamination.
• Ensure that cleaning equipment identified in the cleaning schedule is available.
• Ensure all information available for staff such as the standards for dental care professionals is up to date and reflects the current published version.
• Provide policies and procedures are updated to reflect personnel currently employed at the practice.
• Provide policies on equality and diversity.
• Review all complaints at least annually to identify any trends.
• Update patient satisfaction records to ensure that they are comprehensive and collated monthly in accordance with the practice policy.

We spoke with four patients, all of whom were very complimentary about the practice. They felt that they were treated with dignity and respect. They told us that they were informed about the choices, costs, alternatives and possible outcomes of their treatment. One of the patients told us "The dentists are absolutely brilliant. I am nervous -- it is really good" and another said "Couldn't get better staff". All four of the patients we spoke with found the practice very clean and comfortable.

We found that a patient satisfaction survey had been done in an anonymous manner. From this survey we saw comments like "Thank you for me making me no longer afraid of dentists" and "Very happy with the service and the new dentist". We found that the practice invited feedback and responded when appropriate.

The practice was seen to be friendly, welcoming and informative. We saw that patients were listened to. The surgery was clean throughout and there was evidence of a well-supported staff. There was a supply of patient leaflets in the practice explaining treatment options and other relevant information.

We found that all patients were given sufficient information to give an informed consent, and the staff were well trained and caring. The practice was well led and the staff were observed to be well organised.

We carried out an announced comprehensive inspection on 20 September 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

Hilsea Dental Care provides both private and NHS treatment to patients of all ages. The practice is part of the corporate provider brand Southern Dental Limited. The practice is based in a converted domestic dwelling in Portsmouth, south Hampshire.

The practice has three dental treatment rooms of which all are based on the ground floor and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The ground floor is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs three dentists, two hygienists, two dental nurses, two receptionists and a practice manager who is also a registered dental nurse.

The practice’s opening hours are Monday between 8am and 8pm, Tuesday and Friday between 9am and 5pm, Wednesday and Thursday between 9am and 8pm and Saturday between 9am and 1pm.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

There was no registered manager at the time of our inspection at this location. We were told that the current Practice Manager was registered with CQC at another location nearby and was going through the CQC registration process to become the registered manager of both locations.

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 obtained the views of five patients on the day of our inspection.

Our key findings were:

• Leadership was provided by a newly appointed enthusiastic and hardworking practice manager.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The internal aspects of the practice appeared clean and maintained. We did note issues with some aspects of the outside of the practice.
• There appeared to be sufficient equipment for staff to undertake their duties, and equipment was well maintained. Although improvements could be made to the efficient storage arrangements for dental instruments.
• Infection control procedures generally followed published guidance although there were areas that could be improved. This included protocols around manual cleaning, recording of validation cycles of the automated washer disinfector and the storage of environmental cleaning equipment.
• The practice had effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• 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.
• Staff received training appropriate to their roles and were supported in their continued 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.
• We were told of issues with the company head office responding in a timely way to issues raised by the staff. This included shortages of staff and instruments and because of this staff were not always happy in their work.
• Information from five completed Care Quality Commission (CQC) comment cards gave us a mostly positive picture of a friendly, caring, professional practice.

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

• Review the availability of a hearing loop for patients who wear hearing aids.
• Consider providing the hygienist with the support of an appropriately trained member of the dental team.
• Review the contents of the annual infection control statement in relation to infection prevention control required under The Health and Social Care Act 2008: Code of Practice about the prevention and control of infections.
• Review the storage of processed instruments to make the process of identifying the numbers of instruments required for each clinical session more efficient. Specifically, the practice could consider placing examination packs in one storage box, filling instrument packs in another, dental hand pieces in another and so on.
• Consider discontinuing using the present staff toilet and reverting to using the patient toilet for both staff and patients.
• Consider the provision of a non-foot operated waste bin and mirror for disabled patients in the patient toilet.
• Review the protocols with respect to the manual scrubbing of instruments and the subsequent loading of instruments in the ultrasonic cleaning bath.
• Review the availability of a thermometer for ensuring that the temperature of the water used for manual scrubbing is below the recommended temperature of 45 degrees for this procedure.
• Review the training of nurses in respect of recording the daily validation cycles of the automated washer disinfector.
• Review the safety arrangements of the window blinds in the practice; this should include carrying out a suitable risk assessment of the pull cords.
• Review the checking procedures of the emergency lighting system.
• Review the cleanliness of the external environment of the practice, including the use of the neighbour’s domestic waste bin at the front of the practice and the removal of animal excrement from the back garden area.
• Consider the provision of an external name plate providing details of the dentists working at the practice including their General Dental Council (GDC) registration number in accordance with GDC guidance March 2012.
• Review the recording of the details of the subjects discussed during the staff meetings to capture the standing items which are part of the practice’s policy.