We carried out this announced inspection on 20 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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

J Smallridge Dental Care is in Ipswich and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. There is a lift to the first floor. Car parking spaces are available near the practice.

The dental team includes nine dentists, seven dental nurses, one dental hygienists, one practice manager, a clinical Psychologist and a cleaner. The practice has two treatment rooms and one decontamination room.

Dental specialisms at the practice include Paediatric dentistry, Prosthodontics, Orthodontics, Oral surgery and dentists with special interests in Endodontics and Periodontology. Three of the dental nurses are oralhealth educators and the hygienist can see patients by direct access.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 at J Smallridge Dental Care is the principal dentist.

On the day of the inspection we collected 38 CQC comment cards filled in by patients. Before the inspection we received ten CQC Share Your Experience feedback records which were wholly positive.

During the inspection we spoke with one dentist and three dental nurses. We spoke with the practice manager before the inspection. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 8.30am to 5.30pm.

Tuesday from 8.30am to 5pm.

Wednesday from 8.30am to 5pm.

Thursday from 8.30 am to 8pm, on alternate weeks.

Friday from 8.30am to 4pm.

Saturday by appointment only.

Our key findings were:

• Strong and effective leadership was provided by the principal dentist and an empowered practice manager.
• Information from completed Care Quality Commission comment cards and CQC share your experience feedback gave us a wholly positive picture of a caring, professional and high-quality service.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice staff had robust and well embedded safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs. Appointments were available until 8pm on alternate Thursdays. Saturday morning appointments were available.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

We identified areas of notable practice.

• The principal dentist who was a Consultant Paediatric Dentist, provided and promoted the Pick it, Lick it, Stick it campaign which educated and encouraged patients and first responders to take immediate action to preserve a tooth if knocked out. By repositioning the tooth in the gum immediately the potential for saving the tooth and reducing trauma and bleeding increased. The principal dentist provided free education at multiple local education establishments including schools, children’s nurseries, cubs, beavers, brownie groups and sports groups. Providing oral education and demonstrations on how to deal with dental trauma including teeth that had been knocked out. This included educating the teachers, parents and children and provided demonstrations using models for people to experiment with re-positioning a knocked-out tooth. The practice social media pages promoted the campaign and provided videos of these demonstrations. The principal dentist attended local dentists, paramedics and other clinical teams providing free education on how to deal with dental trauma. We reviewed feedback which praised the practice for the informative educational services delivered.

• Staff described how they provided support for individual patients for whom they need to make adjustments to enable them to receive treatment. The practice clinical psychologist supported patients who experienced high levels of anxiety when attending the practice. Staff described numerous examples of this including agreeing best appointment times for patients with learning difficulties and complete flexibility with patients undergoing treatment for cancer.

• The practice had considered and responded to the needs of vulnerable groups. Children requiring emergency appointments were seen the same day regardless of whether they were a patient of the practice or not. The practice also provided late evening appointments to enable children of secondary school age to attend outside school hours.

• The practice had considered and responded to the needs of patients with special needs, their preferences, wants and particular characteristics were sought from relatives or carers before any appointment was made. This included assessing if they liked or didn’t like music, what noise levels they were comfortable with, what fears they may have of being touched or certain words. All staff were then made aware of these characteristics prior to any appointment and treatment.

There was one area where the provider could make improvements. They should:

• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.