We carried out an announced comprehensive inspection on 13 October 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

The practice is located within a purpose adapted residential dwelling in Dovercourt, Harwich, Essex and offers a range of NHS and private preventative, restorative and cosmetic dental treatments to adult patients and children.

The practice is open between 8am and 6pm on Mondays and between 8am to 5pm from Tuesdays to Fridays.

The practice employs two dentists, six dental nurses, one hygienist and a practice manager. The dental nurses cover reception duties.

The practice is registered with the Care Quality Commission (CQC) as an organisation. The practice manager the registered manager. 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 has three treatment rooms, one of which is located on the ground floor, a combined waiting room and a reception area. Decontamination takes place in a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

We received feedback from 21 patients who completed CQC comment cards prior to our inspection visit. We also spoke with five patients during our inspection visit. Patients made positive comments about the excellent care and treatment that they received. They also commented positively about the cleanliness of the premises, the kindness and responsiveness of staff. Patients told us that staff explained treatment plans to them in a way that they could easily understand. Patients reported that they could access appointments that suited them including on the same day for emergency treatment.

Our key findings were:

• The practice had systems in place for investigating and learning from complaints, safety incidents and accidents. Staff were aware of their responsibilities to report incidents.
• The practice was visibly clean and clutter free. Infection control practices were reviewed and audited to test their effectiveness.
• There were systems in place to help keep people safe, including safeguarding vulnerable children and adults. Staff had undertaken training and were aware of their roles and responsibilities in relation to this.
• The practice reviewed and followed guidance in relation to dentistry. However we found that dentists did not routinely use a rubber dam as recommended to protect patient’s airways when carrying out root canal treatment.
• The practice had the recommended medicines and equipment for use in the event of a medical emergency. Records were maintained in respect of the checks carried out for these medicines and equipment.
• Staff undertook training in respect of their roles and responsibilities within the practice.
• Patients reported that they were treated with respect and that staff were polite and helpful.
• Patients were involved in making decisions about their care and treatments.
• The practice could normally arrange a routine appointment within a few days or emergency appointments mostly on the same day.
• Effective governance arrangements were in place for the smooth running of the service.
• Audits and reviews were carried out to monitor and improve services. Learning from audits and reviews was shared with relevant staff and action plans were developed to secure improvements where these were identified.
• Patient’s views were sought and these were used to make improvements to the service where these were identified.

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.

During our inspection we received positive comments about the quality of the service people received. People told us they were fully satisfied with the care and treatment they received from their dentist. One person we spoke with told us their dentist: "Explains everything and takes great care. She is very professional". Another person said: "It's an excellent service".

We found that dental staff had explained the treatment options to people at the beginning of their consultation and supported people to make informed decisions about their treatment and oral healthcare.

Care records showed people had been given comprehensive dental plans which clearly outlined their treatment.

We found suitable and appropriate infection control processes were in place to ensure people were not exposed to the risks of cross infection and that the appropriate published guidelines had been followed.

All the staff we spoke with said that they felt well supported to do their job and that they received the training they needed.