We carried out an announced comprehensive inspection on 17 March 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

Lincoln Smile Centre is a private dental practice situated in Lincoln. The practice is in a building that has been adapted for the purpose of dentistry and is situated over three floors. The top floor is staff access only. On the ground floor there are two treatment rooms, reception desk with a waiting area, small office area at the back of the reception, a laboratory, x-ray room and a patient toilet. The first floor has two treatment rooms, a decontamination room, a store room, an office and staff toilet. The waiting area has chairs with arm rests to enable ease of use for those with limited mobility. There is also a hot drinks machine, a television and a selection of reading material for the use of patients. The building is accessed from the street and cannot be accessed by wheelchairs as the practice has eight steps leading up to the entrance and there is no alternative entrance and it is impossible to fit a ramp because of the gradient as the practice had made enquiries into this

The practice consists of two dentists, two dental hygienists and seven qualified dental nurses (three of whom have extra responsibilities including receptionist, treatment coordinator and practice manager).

The practice manager is the registered manager of the practice. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered dentists, 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 provides private dental treatment to adults and children. The practice is open Monday to Thursday from 8am to 5pm, Friday 8am to 4.30pm. The practice closes for lunch from 1pm to 2pm other than Friday when it closes 1pm to 1.30pm.

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 51 patients about the services provided. The feedback reflected wholly positive comments about the staff and the services provided. Many of the comments reflected that the practice was clean and tidy. Comments said that they found staff to be professional and caring. They said that the practice offered a welcoming and professional service and they had high confidence in the team. They said that staff were polite, helpful and kind. Patients said that explanations about their treatment were clear. Much of the feedback related to patients that were anxious or nervous and they commented how they were made to feel at ease and that they were able to ask any questions and were given time to make decisions.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in place and staff had access to personal protective equipment.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control.
• Policies and procedures at the practice were kept under review.
• Dentists involved patients in discussions about the care and treatment on offer at the practice. Patient recall intervals were in line with National Institute for Health and Care Excellence (NICE) guidance.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks.
• Patients were treated with dignity, respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum where possible.
• The practice was well-led and staff felt involved and worked as a team.
• Governance systems were effective and policies and procedures were in place to provide and manage the service.
• Staff had received safeguarding training and knew the processes to follow to raise any concerns.
• All staff were clear of their roles and responsibilities.
• There was a process in place for reporting and learning from significant events and accidents.
• Conscious sedation was delivered safely in accordance with current guidelines.
• All staff had been trained in medical emergencies.
• The practice had all the necessary equipment to deal with medical emergencies other than portable suction and an automated blood glucose monitoring device. The portable suction was ordered following the inspection.
• The practice did not have a business continuity plan at the time of inspection however this was completed shortly after.

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

• Review its responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.
• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review dental chair upholstery and surgery flooring in the treatment room and complete risk assessment in relation to infection prevention and control.

People we spoke to said that they received care which met their needs and felt staff communicated with them well. They also said that they felt the practice was clean and that staff used personal protective equipment to ensure hygienic practice.