We carried out an announced comprehensive inspection on 1 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

Spire Dental provides private dental treatment to approximately 700 patients. The practice has recently started to provide conscious sedation. The practice opened in 2013 and has been building up its patients since opening . The practice is on the main street that runs through the village of Long Sutton in Lincolnshire. The practice is converted from a car showroom. The practice has a large and spacious reception area with sofas throughout the waiting area however there were no hard back chairs that may be more suitable for people with mobility issues. There is a separate room used for the pre consultation with the dental nurse which also contains two sofas and fresh flowers and magazines. The practice has been tastefully decorated and thought has gone into making it a comfortable environment for patients. It is a modern practice which allows access all on one level. The practice consists of one treatment room, clean and dirty decontamination rooms, an office and a staff room. There is free parking available on the streets around the practice. The building is accessed from the street and once in the practice, all areas are accessible to people who use wheelchairs.

There are two part time dentists, one of which is a qualified sedationist, two dental nurses (one of whom is also the practice manager) and a receptionist.

The practice provides private dental treatment to adults and to children. The practice is open Monday and Tuesday from 8.30am to 2.30pm, Thursday 8.30am to 5.30pm (late night appointments are available to 7.30pm), Friday 8.30am to 5.15pm and 9am to 12pm alternate Saturdays. The practice is closed Wednesday and Sunday. The practice has a sister practice in Boston and patients could be seen there if they wished or if in an emergency when this practice was closed.

The practice manager 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.

We received feedback from 25 patients about the services provided. The feedback reflected positive comments about the staff and the services provided. Patients commented that the practice was clean and tidy and had a relaxing atmosphere. They said that they found the staff offered a friendly, helpful and efficient service and were polite and caring. Patients said that explanations about their treatment were clear and that they were always informed of what was happening which made the dental experience as comfortable as possible. Patients who were nervous commented how they were made to feel at ease and that any questions were answered.

Our key findings were:

• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in place and staff and patients had access to personal protective equipment.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• Conscious sedation was delivered safely in accordance with current guidelines.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks.
• Clinical audits had taken place however there was only one non clinical audit in relation to records; this was not in line with the Faculty of General Dental Practice guidelines.
• Patients were treated with dignity and 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 opened one late night as well as alternate Saturdays for pre booked appointments.
• The practice was well-led and staff felt involved and worked as a team.
• Staff had been trained to deal with medical emergencies and appropriate medicines and life-saving equipment were readily available and accessible. However, there were no spare pads for the automated external defibrillator and no checks had taken place on it to ensure it was in working order.
• Governance systems were effective and policies and procedures were in place.
• Staff had not received formal safeguarding training but knew the processes to follow to raise any concerns.
• A health and safety risk assessment was in place however this had not been reviewed when it was due in January 2015 to see if there had been any changes.

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

• Adopt a system to ensure validation tests on the ultrasonic cleaner are completed to ensure it is functioning appropriately.
• Review monitoring of emergency equipment to include checks on the defibrillator.
• Ensure risk assessments are reviewed regularly to highlight any changes and identify any new risks.
• Review referral process to include a tracking process of referrals made.