We carried out an announced comprehensive inspection on 6 June 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Combedown Dental Practice is situated in the village of Combe Down, near Bath, with easy access to nearby public car park. It provides general dentistry, including endodontic and restorative services, to mainly NHS patients, but will also treat private patients. The service has three treatment rooms, of which one is downstairs for easy access, one waiting area and an accessible toilet. The practice treats both adults and children.

The practice has three dentists, one trained dental nurse and two trainee dental nurses along with three receptionists.

There is a practice manager who is not yet registered with the Care Quality Commission; however they are in the process of applying to be 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.

The practice is open Monday 09.00am – 5.30pm; Tuesday & Thursday 08.00am – 5.00pm; Wednesday & Friday 8.15am -5.30pm. The practice is open most Saturdays and closed on Sundays. For emergency and out of hour’s assistance contact information is available from the practice telephone answering service.

We reviewed 12 CQC comment cards that had been left for patients to complete, prior to our visit, about the services provided. In addition we spoke with four patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice and these corroborated the comment card responses. Patients commented staff put them at ease, listened to their concerns and provided an excellent service in which they had confidence in the dental care provided.

Our key findings were:

• There were systems in place to help ensure the safety of staff and patients. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies.

• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.

• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.

• Patient records were not wholly stored in accordance with Data Protection guidance. The practice manager told us they had taken action to rectify this and it would be completed in the near future.

• Premises were well maintained and a tour of the building confirmed that good cleaning and infection control systems were in place but not wholly following national guidance; the manager took immediate action to address the shortfalls. The treatment rooms were well organised and equipped, with good light and ventilation.

• There were systems in place to check all equipment had been serviced regularly, including the air compressor, fire extinguishers, oxygen cylinder and the X-ray equipment. The autoclaves while being regularly serviced were not being validated when in use. The manager took immediate action to rectify this.

• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.

• Staff were up to date with current guidelines and the practice was led by a proactive principal dentist.

• Staff were kind, caring, competent and put patients at their ease.

• Patients commented they felt involved in their treatment and that it was fully explained to them.

• Common themes from the CQC comment cards were patients felt they received excellent care in a clean environment from a helpful practice team.

• Information about how to complain was available and easy to understand.

People we met at Combe Down Dental Practice were happy with their treatment and care. One person said their dentist was "absolutely brilliant". Another said they found all the staff "very friendly and helpful". People said they could get an appointment when they needed one. None of the people we talked with had to wait for more than 24 hours in an emergency. They said they felt they would be seen even quicker if they were in too much pain. People said the practice had told them how to get out-of-hours emergency treatment.

We were told the practice was clean and people felt staff were "very aware" of hygiene and infection prevention and control.

We found the practice understood how to gain valid consent from people. Care and treatment provided was safe and effective. There were some areas in instrument decontamination and staff background checks which needed attention, but there was no evidence of people not being safe. Medical records were fit for purpose and held securely.

Staff understood their roles and responsibilities in relation to keeping children and vulnerable adults safe from abuse, including neglect, and what to do if they had concerns.