We carried out an announced comprehensive inspection on 3 November 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

The practice opened in 2009 having taken over a former NHS office building and converting it to a dental practice. Lincoln Dental Care is located on two floors of premises situated on the outskirts of Lincoln close to the ring road. All patient areas are located on the ground floor. The practice provides mostly NHS dental treatments (90%). There is a car park to the rear of the dental practice for patient parking. There are four treatment rooms all of which are located on the ground floor.

The practice provides regulated dental services to both adults and children. Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment.

The practice’s published opening hours are – Monday to Friday: 8 am to 8 pm; Saturday: 9 am to 4:30 pm and Sunday: 9 am to 12:30 pm. However, on the day of this inspection (a Thursday) there were no dental staff available until 2 pm to see patients. The principal dentist said this was due to a dentist being on maternity leave and a replacement dentist not yet having completed their pre-employment checks. The practice has an NHS contract to provide emergency dental services within their identified opening times of 8 am to 8 pm Monday to Friday; 9 am to 4:30 pm on a Saturday and Sunday mornings. However, those contracted hours were not being met. The principal dentist said they had informed NHS England about the difficulties they were facing.

Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message. Alternatively patients could telephone the NHS 111 telephone number.

The provider 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 practice is registered with the Care Quality Commission (CQC) as an organisation.

The practice has three dentists; one dental hygienist; two qualified dental nurses; two trainee nurses and two receptionists.

We received positive feedback from eight patients about the services provided. This was by speaking with patients and through comment cards left at the practice prior to the inspection.

Our key findings were:

• The premises were visibly clean and there were systems and processes in place to maintain the cleanliness.
• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients said they had no problem getting an appointment that suited their needs.
• Patients were able to access emergency treatment when they were in pain.
• Patients provided positive feedback about their experiences at the practice. Patients said they were treated with dignity and respect; and the dentist involved them in discussions about treatment options and answered questions.
• Patients’ confidentiality was protected.
• There were systems to record accidents, significant events and complaints, and where learning points were identified these were shared with staff.
• The records showed that apologies had been given for any concerns or upset that patients had experienced at the practice.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
• There was a whistleblowing policy accessible to all staff, who were aware of procedures to follow if they had any concerns.
• The practice had the necessary equipment for staff to deal with medical emergencies, and staff had been trained how to use that equipment. This included an automated external defibrillator, oxygen and emergency medicines.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

Everyone we spoke with talked positively about the staff and felt they fully supported their care and treatment needs. people told us staff spoke with them in a calm and respectful manner and in words they understood. One person said, "Staff speak to me calmly and always make sure I understand my treatment."

The people we spoke with told us treatment options were always given to them. They told us they knew staff kept records on them and had been asked to complete consent forms prior to commencement of treatment. One person told us,"The dentist is careful with my mouth and face." Another said, "I am asked about my medical history on each visit."

People told us they were happy with the standard of cleanliness in the service and had been offered goggles to wear. One person said, "Staff always wear gloves."

The people who used the service told us the staff looked after them well and knew about different ranges of treatments. One person said, "Staff are brilliant, so knowledgeable."

People knew the complaints procedure was displayed in the waiting room and had read it. One person told us, "I have never had to complain."