We carried out an announced comprehensive inspection on 28 February 2017 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

Jones Dental Care is a dental practice near to the centre of Rugby in Warwickshire. It provides dentistry to adults and children funded privately.

The practice offers general dental treatment and dental implants and also recently started to offer treatment under conscious sedation (these are techniques in which the use of a medicine or medicines produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation).

The practice has four dental treatment rooms and a dedicated decontamination facility. Two treatment rooms are located on the ground floor and are accessible to wheelchair users; however the toilet facilities are not accessible to wheelchair users.

The practice is open from 8 am to 8 pm Monday to Thursday, 8 am to 4 pm on a Friday and Saturday morning appointments are available every six weeks.

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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience. We received feedback from 49 patients. These provided a very positive view of the services the practice provides. Patients commented on the quality of care, the polite and friendly nature of staff and the cleanliness of the practice.

Our key findings were:

• The practice was generally clean and clutter free.

• The practice was taking on patients at the time of the inspection and patients could expect to be offered an appointment within a few days.

• Comments from patients indicated that staff were friendly and helpful and clinicians took the time to explain treatment options.

• Staff used nationally recognised guidance in the care and treatment of patients.

• The practice met the national guidance in infection control measures.

• Emergency medicines were in place to treat medical emergencies in line with national guidance.

• The practice had policies in place to assist in the smooth running of the service.

• Appropriate pre-employment checks were being carried out to ensure the service employed fit and proper persons.

• The practice did not always follow recommendations of risk assessments, for example; the training of staff in Legionella awareness.

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

• Review the current legionella risk assessment and implement the required actions including the training of staff, giving due regard to the 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 protocols for conscious sedation, giving due regard to 2015 guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

• Review the practice’s audit protocols of various aspects of the service, such as radiography at regular intervals to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

People we spoke with said they were very happy with the service they received. One person said she had been coming to her particular dentist for a number of years. She told us she now travelled a number of miles to continue to use the practice. People we spoke with knew how to complain but never had cause to do this.

One of the people we spoke with used a wheelchair. We were told “I’m a wheelchair user and don’t have any problem getting in and out of the surgery. The treatment room is downstairs. I can’t transfer to the dentists’ chair. The dentist does all my treatment in my wheelchair, he is brilliant.”

We asked about being able to get an appointment and if they had to wait over their appointment time to be seen. People told us that “The reception staff are excellent and they will always fit you in” and “I never have to wait.”

The practice manager described the on call arrangements and how this was shared with other practices. People told us: “I have used the surgery in an emergency and was able to get an appointment that day.”

Staff spoken with told us that they were very happy working at the practice and that most of the staff had worked there for a number of years. Staff said that there was a “good team” and that they supported one another.

We asked one of the nurses about the actions they took if there was a medical emergency. The nurse was able to describe what they would do to make sure the person was treated quickly.

People we spoke with said everything always looked clean. One person said “The surgery is always clean whenever I go, another said “Very good on that point.” People confirmed that the dentists and nurses always offer them glasses to protect their eyes. We were told the dentists wear these themselves and that they always wear disposable gloves. Staff said there was always a sufficient supply of gloves, aprons, hand wash, gels and other items required to ensure standards of care.

Staff spoken with told us that they had attended training in the decontamination of equipment and infection control. Staff said they felt confident with the procedures and that there was additional guidance to follow if needed. Staff were able to show us the decontamination process and describe how the equipment was monitored to ensure it was working efficiently.