We carried out an announced comprehensive inspection on 30th August 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

Mydentist Old Market is located in the Old Market area of Bristol and provides NHS and private treatment to patients of all ages. The practice consists of four treatment rooms, toilet facilities for patients and staff, a reception, a waiting area, an office and a staff room.

The practice treats both adults and children. The practice offers routine examinations and treatment. There are two dentists, two locum dentists and a hygienist.

The practice’s opening hours are

8.30 to 18.30 on Monday

8.30 to 18.30 on Tuesday

8.30 to 18.30 on Wednesday

8.00 to 18.30 on Thursday

8.30 to 18.30 on Friday

Out of hours the practice provided contact information for other IDH dental practices with different opening hours, for the dental hospital and for NHS 111.

We carried out an announced, comprehensive inspection 30th August 2016. The inspection took place over one day. The inspection was led by a CQC inspector. They were accompanied by a dental specialist advisor.

Before the inspection we looked at the NHS Choices website. In the previous year there had been 17 comments about the practice. The practice received an average of 1.5 stars. The organisation responded to all the comments and offered to follow up any issues with patients who responded.

For this inspection 11 people provided feedback to us about the service. Patients were positive about the care they received from the practice. They were complimentary about the service offered which most patients said was good and two said was excellent. They told us that staff were professional, kind, caring and friendly. Patients told us that the practice was clean and hygienic. We received no negative comments.

Our key findings were:

• Safe systems and processes were in place, including a lead professional for safeguarding and infection control.

• Staff recruitment policies were appropriate and most of the relevant checks were completed. Staff received relevant training.

• The practice had ensured that risk assessments were in place and that they were regularly reviewed.

• The clinical equipment in the practice was appropriately maintained. The practice appeared visibly clean throughout.

•The process for decontamination of instruments followed relevant guidance.

• The practice maintained all appropriate dental care records and patients’ clinical details were updated suitably.

• Patients were provided with health promotion advice to promote good oral care.

• Written consent was obtained for dental treatment.

• One of the dentists was aware of what process to follow when a person lacked capacity to give consent to treatment.

• All feedback that we received from patients was positive; they reported that it was a caring and effective service.

• There were sufficient governance systems in place at the practice such as systems for auditing patient records and radiographs.

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

• Review the recruitment process to ensure that two written references are obtained when recruiting new staff.

• Review the deployment of staff to ensure the hygienist is supported by a dental nurse.

This inspection took place to follow up concerns found at our visit to the practice in June 2013. During the visit in June 2013, we found that the arrangements in place for the decontamination of dental instruments did not meet with the requirements of the Health Technical Memorandum 01-05 (HTM 01-05). This is the guidance that all dentists must follow to ensure that their practice is safe and minimises the risks of cross infection. We also found that the systems in place for monitoring the quality of the service were limited and were insufficient for the provider to be able to identify and act on any concerns that arose.

When we returned to the service in November 2013, we found that improvements had been made. The room used for the decontamination of dental instruments had been fully refurbished in line with the HTM 01-05. A programme of audits had been undertaken so that people using the service could be assured that any issues or concerns in the running of the service would be identified.

People using the service told us that they were satisfied with the treatment they'd received. We were told that treatment was well explained and the costs were made clear. Medical histories were taken from people and there were procedures in place in order for staff to manage medical emergencies.

Staff had been trained in safeguarding procedures so that they would be able to recognise and act on the signs of abuse. Staff were also aware of the Mental Capacity Act 2005 and how this may impact on dentistry.

We found that the procedures in place did not meet with the requirements of the Health Technical Memorandum 01-05. This is the guidance that all dentists must follow in order to minimise the risks of cross infection. There were some systems in place to monitor the quality and safety of the service. However, these were not sufficient to be sure that the provider would be able to identify concerns and issues through their own monitoring.