We carried out this announced inspection on 13 November 2017 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. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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 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

Mydentist - Priory Way - Malmesbury is situated on the outskirts of the town in the purpose built health park. It provides NHS and private treatment to patients of all ages.

There is level access into the building and a lift to the surgery premises for people who use wheelchairs and pushchairs. When in the surgery there is level access throughout. Car parking spaces are available in front of the practice. There are marked parking spaces for patients with disabled badges.

The dental team includes five dentists one of whom is an implantologist, three dental nurses and three trainee dental nurses, a practice manager and two receptionists. The practice has four treatment rooms.

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. The registered manager at Mydentist - Priory Way - Malmesbury was the practice manager.

On the day of inspection we collected 11 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses and one trainee dental nurse, a receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday, Tuesday and Thursday 9am – 5.30pm
• Wednesday 9am – 7pm
• Friday 8am - 4.30pm
• Saturdays 8.30am -11.30am
• Out of hours information displayed on website and via telephone answering service

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved, supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

There were areas where the provider could make improvements. They should:

• Review the practice recruitment procedures relating to the use of agency staff to ensure that appropriate background checks are completed prior to them working in the practice.
• Regularly monitor and record water temperatures as part of the Legionella risk assessment taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices. Take action when water temperature readings do not meet the requirements.
• Review staff training to ensure all staff had undergone relevant training, to an appropriate level, in the safeguarding of children and vulnerable adults.

• Review the current performance review systems in place and have an effective process established for the on-going assessment and supervision of all staff.

• Review the practice’s systems for analysing the results of audits and reviews to identify, share and act on areas for improvement where appropriate.

We spoke with eight people attending for check ups or treatment, two dentists, nurses, the receptionist and practice manager.

People said they were happy with the service and one person described it as “excellent”. They told us that this dentist was better than their previous one because they felt there was “always a perfect finish to treatment”.

There was one person who had a difficult tooth extraction. They said the treatment they had received was “delightful”. Other people said “treatment has been fine” and “I was happy to get an emergency appointment the next day”.

We met a husband and wife. The wife was attending for treatment but was unable to use the dental chair because of restricted mobility. The husband had discussed how treatment could be achieved with the dentist. A resolution was to tilt the person’s wheelchair and place it on blocks. This enabled the person to receive treatment from the dentist at the correct angle.

All of the staff were positive about working at the practice and told us they felt supported not only by the manager, but by each other. Staff were aware of the need to protect children and vulnerable adults and received relevant training.

There was information to help people understand dental treatments. People were happy with the treatment they received some said it was “pain free”. There were good records of people's treatment.

Arrangements were in place to protect people’s well-being and safety.