We carried out an announced comprehensive inspection on 9 March 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

HRS Dental Care is situated in a converted residential building in Stonehouse, Gloucestershire. It provides private dental care with a small children only NHS provision. The practice clinical team comprises of the principal dentist, two dental therapists, one dental hygienist and three qualified dental nurses. The clinical team are supported by one practice manager and two receptionists.

The principal dentist is registered with the Care Quality Commission (CQC) as 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 practice has three dental treatment rooms, a small laboratory for making study models, gum shields and whitening trays and a decontamination room for the cleaning, sterilising and packing of dental instruments. The reception area and main waiting room are on the ground floor. There is one surgery on the ground floor.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to use to tell us about their experience of the practice. We collected three completed cards and spoke to one patient on the day of our inspection. Without exception patients were positive about the quality of the service provided by the practice. They gave examples of the positive experiences they had at the practice and told us the practice team were professional, caring and helpful. All the patients commented that they received high quality treatment and they were happy with the results. We looked the practice’s NHS Friends and Family results for January 2016 where 100% of patients who completed the survey would recommend HRS Dentalcare Ltd.

Our key findings were:

• Patients who completed CQC comment cards were all positive about the practice team and the care and treatment provided.
• The practice had an established process for reporting and recording significant events and accidents to ensure they investigated these and took remedial action.
• The practice was visibly clean and an employed cleaner was responsible for the day to day cleaning. However there was no cleaning schedule in place and equipment was not stored correctly or designated according to the latest National Patient Safety Association guidance (NPSA). Since our inspection the provider have evidenced that there is now a full and comprehensive cleaning schedule in place and the cleaner has been fully trained in all aspects. The cleaner now completes regular check lists to ensure that the cleaning complies with the relevant guidance from the NPSA.

• The practice had well organised systems to assess and manage infection prevention and control. However there was no process in place for managing blood or bodily fluid spillages and the use of hypochlorite solution as detailed in the Department of Health infection control and prevention Code of Practice. A spillage kit was ordered the same day as the inspection and arrived the following day. All clinical staff have been trained in it

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• The practice had appropriate safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines. However, consumable items such as syringes and airways were found to be past their expiry dates and the emergency kit did not contain a paediatric face mask for the emergency self-inflating bag. Any expired dressings were immediately replaced by the practice and the appropriate paediatric face mask is now stored as part of the emergency kit. The systems have been changed to ensure that all sterile dressings are reviewed to ensure that expiry dates are not missed.

• The practice had recruitment policies and procedures and used these to help them check the staff they employed were suitable for their roles.
• Dental care records provided comprehensive information about patients care and treatment.
• Staff received training appropriate to their roles and were supported in their continuing professional development.
• Patients were able to make routine and emergency appointments when required.
• The practice had systems including audits to assess, monitor and improve the quality and safety of the services provided. However, the practice process and procedure for dispensing medicines did not fully reflect the requirements of the Human Medicines Regulations 2012.
• The practice had systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors.

We spoke with people when we visited the practice who were attending for treatment or check-ups. They told us that they were very happy with the service they received and had been attending the practice for many years. We were told that they were involved in making decisions about treatment plans, were given explanations about any options available, and were informed of costs involved which included estimates of future treatments.

The General Dental Council registration was up to date for the dentist and the qualified dental nurses. They had to submit evidence of continued professional development (CPD) every three years in order to retain their registration. We looked at staff files and saw evidence that confirmed this.

Staff we spoke with were aware of the Department of Health guidance for dental practice decontamination: Health Technical Memorandum (HTM) 01-05. The lead dental nurse had responsibility for infection control and decontamination procedures.

Arrangements were in place to deal with unforeseeable emergencies.

All staff had received their annual medical emergencies and cardio-pulmonary resuscitation (CPR) training. We saw the training certificates to evidence this.

We spoke with four people who used the service. They all made favourable comments about their experiences.

One person told us that they had been attending the practice since it opened and never had any problems. They said that the practice was accommodating if appointments needed to be changed. They told us that the dentist explained their treatment to them and they signed to give consent. This person took their family with them and said the dentist spoke to their children as individuals and demonstrated a genuine concern for people’s welfare. They said that the dentist gave children the encouragement to clean their teeth properly. These comments were echoed by another parent who said that this was the best dentist they had ever used.

Another person described the practice as efficient and talked about the good service they had received. They said they travelled a considerable distance but that it was worth it.

People we spoke with said they would speak to the dentist if they had cause for concern about any aspect of the service. None of the people we spoke with had any concerns.

People said they appreciated the reminders of their appointments that they were sent.

We spoke with staff who said that the practice was a good place to work. They talked about the importance of instilling confidence in people in order to allay their fears about dental treatment.