We carried out an announced comprehensive inspection on 26 February 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

Lawrence Weston Dental Practice is a mixed dental practice providing NHS treatment and some private treatment for both adults and children. The practice is situated in a converted residential property. The practice had two dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments. Also included were a reception and waiting area.

The practice is open 9.00am - 5.00pm Monday to Thursday and Friday 9.00am - 1.00pm.The practice has one full time dentist and two other dentists working part-time over the course of a week and are supported by three dental nurses and two receptionists.

The practice owner 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. The registered manager was supported in their role by the lead dental nurse who acted as practice manager.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 43 patients. These provided a completely positive view of the services the practice provides. Patients commented on the high quality of care, the caring nature of all staff, the cleanliness of the practice and the overall high quality of customer care.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Effective leadership was provided by the practice owner and the practice manager/lead dental nurse.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared very clean and well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• 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 recruitment files were organised and complete.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD) by the practice principal and practice manager.
• Staff we spoke with felt well supported by the practice owner and practice manager and were committed to providing a quality service to their patients.
• Information from 43 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.

Since our last inspection, the practice had closed in order to take a number of improvement actions. During this time, no patients had received treatment at the practice.

During this inspection we spoke with five members of staff including the provider (principal dentist), an associate dentist, two dental nurses and a receptionist. We also reviewed records relating to the management of the service. No patients were scheduled to receive care and treatment on the day of our inspection.

We found the practice had processes in place to ensure before patients received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Patients’ needs were assessed and care and treatment was planned and delivered in line with their individual care plan. There were arrangements in place to deal with foreseeable emergencies.

Patients were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening .We found the practice had effective systems in place to reduce the risk and spread of infection. The practice was clean and hygienic and a process was in place to ensure appropriate cleaning standards were maintained.

Patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had effective systems to assess and monitor the quality of service provided. There were systems in place to identify risks to the health and safety of patients, staff and visitors. Comments and complaints were used to improve the service and there were systems in place to ask patients for their views on the care and treatment they received.

We found clinical patient records and records relating to the management of the service were accurate and fit for purpose. Systems were in place which ensured records were kept securely, could be located promptly when needed and were destroyed securely within appropriate timescales.

This inspection was undertaken following information of concern received from an anonymous whistle blower to NHS England, which was shared with us.

On the day of our visit we spoke with two patients who were complimentary about the practice. Both felt they were treated with respect and dignity. Both patients told us they were informed about the treatment alternatives and possible outcomes of the treatment.

The practice had disabled access and there were some arrangements in place to communicate with patients whose first language was not English.

We spoke with four members of staff about the running of the practice and the support they received from management. We observed staff could access on line training. However the practice had no system for appraisal and ensuring learning was applied in practice.

During the inspection we found there were risks of unsafe care and treatment. We observed consent to care and treatment was not always sought or recorded.

We saw there were risks of harm to health and well-being through limited notes regarding examination or treatment and there was no evidence of comprehensive treatment planning for the protection and well-being of patients. We also found unsafe storage and management of emergency medicines.

We observed the decontamination processes and storage of instruments and saw there was a risk of acquiring a healthcare associated infection because the practice did not have effective systems in place to prevent and control infections.

We looked at records and asked staff about how the quality of the service was monitored. We found there were few systems in place to monitor the quality and safety of the practice for the well-being of patients.

We spoke with four people who used the service on the day of our visit. We were told that medical histories were taken regularly and that advice was given following a course of treatment. People told us that they could make appointments easily. One person told us that they had chosen to stay with the practice even though they had moved out of the area.

Treatment plans were provided to some people, and for others treatment options were discussed verbally. People that we spoke with confirmed that information about their treatment and the available options had been given to them.

We saw that there were ways in which people could provide feedback on the service they received through questionnaires and the complaints process.

We looked at the procedures for infection control and decontamination of dental instruments and found that although procedures were in place, improvements in this area were required.