We carried out this announced inspection 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. A CQC inspector, who was supported by two specialist dental advisers, led the inspection.

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

Manor House Dental Surgery is a well-established practice based in the village of Long Stratton. It provides mostly NHS treatment to patients of all ages, although at the time of our inspection, the practice was not accepting any new NHS patients for registration. The dental team includes three dentists, seven dental nurses, three hygienists and two receptionists. A practice manager is in day to day control of the service. It is one of six practices owned by Simply Smile Limited.

The practice has four treatment rooms and is open on Mondays to Thursdays from 9am to 5.30pm, and on Fridays from 9am to 4.30pm.

There is level entry access for people who use wheelchairs and pushchairs.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. There are two registered managers at the practice:Susan Wright Practice manager and Mark Ter-Berg dentist.

During the inspection we spoke with the practice manger, the clinical lead, three dentists, three dental nurses and reception staff. We looked at the practice’s policies and procedures, and other records about how the service was managed. We collected 47 comment cards filled in by patients and spoke with another five on the day.

Our key findings were:

• The practice had systems to help ensure patient safety. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control, and responding to medical emergencies.

• The practice had adopted a process for the reporting of untoward incidents and shared learning when they occurred in the practice

• Risk assessment was robust and action was taken to protect staff and patients.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance. Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration.

• The practice dealt with complaints positively and efficiently.

• The practice proactively sought feedback from patients, which it acted on.

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.

We carried out an announced comprehensive inspection on 6 May 2015 The practice has three dentists; two are fulltime and one works 16 hours per week. In addition there are seven dental nurses (three of which are in training) and four dental hygienists. There is a practice manager, a financial manager and a receptionist. The practice provides primary dental services to both NHS and private patients. The full time dentists provide both NHS and private treatments and the dentist who works 16 hours per week sees predominantly private patients. The practice is open Monday to Friday between 9.00 am and 5.00 pm. 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 spoke with two patients and reviewed 24 CQC comment cards which had been completed by patients prior to the inspection. All of the comments reflected positively on the staff and the services provided. Patients commented that the practice was clean and hygienic, they found it easy to book an appointment and they found the quality of the dentistry to be excellent. They said explanations were clear and that the staff were kind, caring and reassuring. The provider was providing care which was safe, effective, caring, responsive and well-led and the regulations were being met.

Our key findings were:

• The practice recorded and analysed significant events and complaints and cascaded learning to staff.
• Where mistakes had been made patients were notified about the outcome of any investigation and given a suitable apology.
• Staff had received safeguarding and whistleblowing training and knew the processes to follow to raise any concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to handle emergencies, appropriate medicines and life-saving equipment were readily available.
• Infection control procedures were robust and the practice followed published guidance on the majority of occasions, however, there were minor areas for improvement.
• Patient care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• 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.
• There was an effective complaints system and the practice was open and transparent with patients if a mistake had been made.
• The practice was well-led, staff felt involved and worked as a team.
• Governance systems were effective and there was a range of clinical and non-clinical audits to monitor the quality of services.
• The practice sought feedback from staff and patients about the services they provided.

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

• Improve some aspects of infection control procedures in line with published guidance.
• Commission a current fire inspection for the building.