We carried out an announced comprehensive inspection on 3rd November 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 Calne is located in the centre of Calne and provides NHS and private treatment to patients of all ages. The practice consists of two treatment rooms, toilet facilities for patients and staff, a reception/ waiting area and a staff room.

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

The practice’s opening hours are

8.30 to 17.00 on Monday

8.00 to 17.30 on Tuesday

8.30 to 17.00 on Wednesday

8.00 to 18.00 on Thursday

8.30 to 17.30 on Friday

We carried out an announced, comprehensive inspection on 3rd November 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 four reviews about the practice ranging from 1 star to 5 stars. The organisation responded to all the comments and discussed the learning points with staff.

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 they said was excellent. They told us that staff were helpful, caring and friendly. Patients told us that the practice was safe, clean and hygienic. We received no negative comments.

Our key findings were:

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

• Staff recruitment policies were appropriate and 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 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.

• The dentist 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 governance systems in place at the practice such as systems for auditing patient records, infection control and radiographs.

• The service sought feedback from patients and made changes in response to feedback and complaints.

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

• Review the process for decontamination of instruments to reduce the risk of water spillage on to the floor.

• Provide a suitable sign on doors of rooms where oxygen is stored.

• Review the process for onward referral to other professionals to include offering a copy of the referral letter to the patient.

We carried out an announced comprehensive inspection on 8th December 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 not 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 Calne is located in the centre of Calne and provides NHS and private treatment to patients of all ages. The practice consists of two treatment rooms, toilet facilities for patients and staff, a reception/ waiting area and a staff room.

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

The practice’s opening hours are

8.30 to 17.00 on Monday

8.30 to 17.30 on Tuesday

8.30 to 17.00 on Wednesday

8.00 to 18.00 on Thursday

8.30 to 17.30 on Friday

We carried out an announced, comprehensive inspection on 8th December 2015. 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 five comments about the practice. Two comments were very positive, two comments were complaining about the costs and one was complaining about poor treatment. The organisation responded to all the comments and discussed the learning points with staff.

For this inspection 13 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 they said was good. They told us that staff were professional, 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 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 not 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 did not follow relevant guidance.

• The practice did not maintain all appropriate dental care records and patients’ clinical details were not 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 not 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 not sufficient governance systems in place at the practice such as systems for auditing patient records.

We identified regulations that were not being met and the provider must:

Make sure they obtain satisfactory information about the conduct of prospective new staff in their previous employment in services relating to health or social care, or children or vulnerable adults.

You can see full details of the regulations not being met at the end of this report.

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

• Review and where necessary update the COSHH assessments.

• Re-order the glucose injections and either keep the new supply in the fridge or adjust the expiry date in line with the directions.

• Make sure that staff follow relevant guidance when cleaning and sterilising instruments

• Make sure the dentists are trained about the Mental Capacity Act 2005 and understand how to put this into practice.

• Make sure all the necessary records are in place for each patient and keep these up to date.

• Conduct fire evacuations regularly, at least every six months.

• Obtain two written references when recruiting new staff.

• Provide training for staff about equality and diversity.

• Provide training for the dentists and staff about the Mental Capacity Act (MCA) and codes of practice so that they will know what to do if an adult lacks the capacity to make particular decisions for themselves.

• Keep a record of the training for the dentists in the practice.

• Review and update the policies.

• Develop effective systems for auditing of patient records.

A single inspector conducted the inspection and helped to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, from speaking with patients who use the service, speaking with the staff and from looking at records. We spoke with three patients after they had had their appointments.

Is the service safe?

For each patient risk factors were identified as part of their health assessment. There were also general risk assessments with measures to reduce risk so that the patients and the staff were kept safe. There was emergency equipment and medication to make sure that patients were kept safe if there was a health emergency.

The general environment and the surgeries were clean and tidy. There were hand-washing facilities for staff and there were cleaning schedules and decontamination procedures to reduce the risk of infection.

There were enough staff so that they were not rushed and could respond to patients calmly. Staff had a range of qualifications and training so that they had the right skills to provide a service and to keep patients safe.

The dentists conducted regular audits to make sure that the service was safe.

Is the service effective?

Patients’ health and needs were assessed and each patient had a detailed treatment plan to improve their dental health. Patients were asked to give their consent to assessment and treatment and signed their treatment plans to show their consent. The three patients we spoke with said that they had given their consent to treatment.

The health assessments and dental examinations identified potential risks to patients’ health. Patients were given advice to improve their oral health and appropriate support and treatment.

The practice had staff with appropriate qualifications and training including dentists, dental nurses and receptionists. Staff updated their training so that they had the knowledge and skill to offer effective treatment and advice.

Is the service caring?

We saw that patients were treated with respect and dignity by the staff. Patients came to the reception and were received by staff who were courteous and helpful. Patients told us that communication was very good and the dentists listened to what they had to say. The dentists gave patients advice about how to prevent problems and manage dental conditions.

There was also written information for patients about prevention and some dental conditions. Patients were supported through advice and their treatment plans to manage their own dental health and wellbeing.

Is the service responsive?

The appointment system was straightforward so that patients could access the service easily. Changes had been made to the opening time and the scheduling of appointments to make them more flexible.

The service was planned to take account of different needs in relation to age, gender, disability, culture and religion. For example the service was available to patients of all ages, different genders and cultural backgrounds. The surgeries did not have level access. Patients with poor mobility, including patients who used wheelchairs, were offered treatment at another practice which they could visit more easily.

Patients could give their views about the service through feedback forms and where shortfalls or concerns were raised these had been addressed. The service was introducing a feedback system using texts to offer more opportunities to patients to give feedback.

Patients knew how to make a complaint if they were unhappy. Action was taken in response to complaints.

Is the service well-led?

The service had a quality assurance system so that the quality of the service was continually audited and monitored. We saw records, which showed that all checks were taking place and the service provided was safe and of the right quality.

Staff we spoke with were clear about their roles and responsibilities. There were enough staff to provide the service and offer a flexible appointments system.

Support to staff from the organisation was good. For example a manager from another practice had visited for the day of our inspection to support the practice manager.

People we met at the practice were happy with their care and treatment. They said care was "very good" and "absolutely fine." All the people we spoke with told us they would recommend the practice to friends and family. They said they were able to make their own decisions and gave valid consent to any treatment. People said treatment costs were clear and treatment had been effective. Patients said they felt confident about complaining if they needed to and felt they would not be discriminated against if they complained.

People were given information about proposed treatment options and were asked for their consent before treatment was provided. When people lacked capacity to make their own decisions the staff knew how to act in people's best interests. Clinical staff were trained and equipped to deal with medical emergencies. People were treated by staff who had been trained and appraised in their work. Complaints were listened to and acted on effectively. The practice was clean and followed guidance around decontamination and infection prevention and control.