We carried out this announced inspection on 11 January 2019 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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

Lindfield Dental Surgery is in Amersham and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs, those with pushchairs at the front of the practice. Car parking spaces, including space for blue badge holders are available in the practice car parking area.

The dental team includes three dentists, two dental nurses, two trainee dental nurses, one dental hygienists and a practice manager. The nursing staff also cover reception. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of our inspection we collected 46 CQC comment cards filled in by patients and obtained the views of 13 other patients.

During the inspection we spoke with two dentists, two dental nurses, one trainee dental nurse, one dental hygienist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open 8.30am to 5.30pm Monday, Thursday and Friday, 8.30am to 8pm Tuesday and Wednesday and 8.30am to 1.00pm on Saturday.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• Improvements were required to several areas of the practice all of which have been addressed since our visit.

During our previous inspection on 7 August 2013 we were concerned the provider did not have mechanisms in place to regularly seek the views of patients to enable them to make an informed decision in relation to the standard of care and treatment provided to patients.

During this inspection we read a questionnaire that had been issued to patients for feedback. We discussed the findings with the provider and another staff member, they were able to describe how they had implemented changes to their procedures for example they ensured patients understood the cost of treatment prior to it being carried out. We saw documentation to demonstrate this was now their practice.

During our previous inspection on 7 August 2013 we were concerned the provider did not bring the complaints procedure to the attention of patients. During this inspection we found the complaints procedure was available to patients in the waiting room. This ensured patients knew how to make a complaint and how the complaint would be dealt with.

We spoke with seven patients including two children who all spoke positively about the dental practice and the treatment they received. One child told us they liked coming to the dentist as they trusted the dentist. Another patient told us they thought the practice was “fantastic.” We were told the dentist “Only always makes suggestions, and it was up to me to decide what I wanted to do… I feel totally confident with what he (Dentist) is doing.”

We read documentation relating to five patients notes. We found evidence their medical histories had been documented and that treatment plans had been discussed prior to treatment. Patients told us their verbal consent was given once they understood the treatment options available.

We found the practice appeared clean and hygienic. We noted that the manual cleaning practice of cleaning instruments was not in line with Department of Health best practice, Health Technical Memorandum 01-05 (HTM 01-05). Decontamination and infection control policies and procedures were in place to minimise the risk of unsafe practices. We saw evidence these were regularly checked to ensure the safety of service.

We saw the provider carried out regular audits and checks of procedures and equipment, and that a complaints policy was in place. The provider had a complaints procedure in place however, it had not been made accessible to patients. We saw how the provider had responded appropriately to complaints and comments made by patients.