We carried out an announced comprehensive inspection on 3 November 2015 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

Mackworth Dental practice was registered with the Care Quality Commission (CQC) in June 2011 to provide dental services to patients in the city of Derby and the surrounding areas. The practice provides both NHS and private dental treatment, with approximately 95% being NHS patients. Services provided include general dentistry, dental hygiene, teeth whitening, crowns and bridges, and root canal treatment.

The practice is open Monday to Friday from 8:30 am to 5:30 pm. Access for urgent treatment outside of opening hours is usually through the NHS 111 telephone line.

The practice has two dentists; one hygienist/ therapist; four dental nurses; and one practice manager. Dental nurses also work on reception.

The practice did not have a registered manager at the time of our inspection. The practice manager was in the process of applying to be the registered manager.  A registered manager is a person who is registered with the Care Quality Commission (CQC) 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 20 patients about the services provided. We saw that feedback was wholly positive. Patients said they were very satisfied with the service provided, and spoke positively about their experience at this dental practice. Patients said they were treated well, and that staff were friendly and approachable. Patients were able to ask questions, and the dentist explained the treatment options and costs.

Our key findings were:

• The practice formally recorded accidents, significant events and complaints.
• Learning from any complaints and significant incidents were recorded and learning was shared with staff.
• All staff had received whistle blowing training and were aware of these procedures and the actions required.
• Patients provided positive feedback about the dental service.
• Patients said they were treated with dignity and respect.
• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies.
• Emergency medicines, an automated external defibrillator (AED) and oxygen were readily available. An AED is a portable electronic device that automatically diagnoses life threatening irregularities of the heart and delivers an electrical shock to attempt to restore a normal heart rhythm.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control.
• Patients’ care and treatment was planned and delivered in line with National Institute for Health and Care Excellence (NICE) guidelines.
• Not all of the policies and procedures in use at the practice had been reviewed.
• Patients were involved in making decisions about their treatment
• Patients’ notes did not always reflect the reason for and clarity of X-rays taken at the practice.
• Options for treatment were identified and explored and discussed with patients.
• Patients’ confidentiality was maintained.

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

• Display the instructions for the use of sharps bins beside any sharps bin as detailed in Health and Safety (sharp instruments in healthcare) Regulations 2013.
• Review the clinical notes for patients’ who have had radiographs to ensure that X-rays were graded, the views taken were recorded, and the justification for taking the X-ray and the clinical findings were clear.
• Review all policies and procedures at the practice to ensure staff have the latest and most up-to-date information and guidance.

People we spoke with told us they were involved in decisions about their care and treatment options. This was confirmed by our observations on the day. One person told us "The staff are very friendly here and the dentist is brilliant with children".

People told us they felt the practice delivered care and treatment in a way that met their needs and felt safe when they had treatment. One person told us "I've been coming here a couple of years and it is great. My family come here as well".

Staff could give us examples of types of abuse and possible signs of abuse. They were also aware of the reporting procedure for safeguarding issues.

We saw that there were effective systems in place to reduce the risk and spread of infection.

The provider has effective recruitment and selection procedures in place and carries out relevant checks when they employ staff.

The provider had clear systems in place to obtain feedback from all persons involved in the service as well as auditing their own service.