We carried out an announced comprehensive inspection on 8 December 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

Knutsford Road Dental Clinic is located in a residential suburb close to the centre of Wilmslow. The practice’s reception, waiting room and treatment room are situated on the ground floor. The practice is accessible to patients with disabilities, mobility difficulties, and to wheelchair users. There are fully accessible patient toilet facilities also on the ground floor. Parking is available outside the premises. The provider has been providing dental services from this location for two years.

The practice provides general dental treatment and emergency dental treatment to patients on a privately funded basis. The opening times are Monday, Wednesday and Friday 9.00am to 5.30pm, Tuesday and Thursday 9.00am to 7.30pm, with emergency appointments available outside these hours. The practice is staffed by a principal dentist, a practice manager / trainee dental nurse / receptionist, and a trainee dental nurse / 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.

We received feedback from nine people during the inspection about the services provided. Patients commented that they found the practice excellent, and that staff were polite, friendly, and caring. They said that they were given detailed explanations about dental treatment, and that the dentist listened to them. Patients commented that the practice was spotlessly clean and comfortable. Several patients with severe dental anxieties commented that the dentist and staff made them feel calm and relaxed during treatment.

Our key findings were:

• The practice had procedures in place to record and analyse significant events and incidents.
• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
• The premises and equipment were clean, secure and well maintained.
• Staff followed current infection control guidelines for decontaminating and sterilising equipment.
• 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 24 hours a day.
• 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.
• The practice gathered the views of patients and took their views into account.
• Staff were supervised, felt involved, and worked as a team.
• Governance arrangements were in place for the smooth running of the practice, and for the delivery of high quality person centred care.
• Staff had received safeguarding training, and knew the processes to follow to raise concerns. One member of staff had not updated their training recently.
• Staff had been trained to deal with medical emergencies, and emergency medicines and equipment were available, with the exception of a portable suction device.

We identified the practice did the following which had a positive impact on patient experience and health outcomes.

The provider was aware of the difficulties experienced by patients of both NHS and private dental services in obtaining immediate emergency appointments and treatment. The provider had set up Knutsford Road Dental Practice to provide 24 hour emergency appointments alongside a routine dental treatment. Appointments were available for patients to obtain not only pain relief but also, for example, restoration of broken teeth and cosmetic treatment.

The service received a high number of patients who were not regular dental attenders, a significant proportion of which were patients with dental anxieties. These patients were allocated appropriate length appointments to allow the dentist to provide treatment but also to allow the dentist and staff to assist in helping the patients to overcome their fears.

The dentist telephoned emergency patients on the day following their appointment to check on their well-being and the treatment provided.

The provider explained the emergency appointments also provided an important opportunity to deliver a positive experience of dentistry. Patients with no regular dentist were offered the opportunity to return for a full dental examination appointment at no cost. We saw several examples of feedback from dentally anxious patients confirming they had returned for on-going treatment and become regular attenders.

This demonstrated a commitment to improving access to dental treatment, promoting a good quality of life to patients and supporting patients to achieve positive outcomes, in respect of their oral health.

We believe this to be notable practice worth sharing as it demonstrates involvement with the local and wider community to make sure people’s needs are met.

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

• Review the availability of equipment to manage medical emergencies having due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council standards for the dental team.
• Establish whether the practice is in compliance with its legal obligations under the Ionising Radiations (Medical Exposure) Regulations 2000, in relation to the undertaking of X-ray audits, and review the frequency of the infection control audits.
• Establish an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities, specifically in relation to staff working in a clinical  environment prior to the determination of the effectiveness of the Hepatitis B vaccination.