We carried out an announced comprehensive inspection on 4th 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

Mydentist Shepton Mallet is located in the centre of Shepton Mallet, in Somerset, 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, two waiting areas, an office 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 and more dentists are being recruited.

The practice’s opening hours are

8.30 to 19.00 on Monday

8.30 to 17.00 on Tuesday

8.30 to 17.00 on Wednesday

8.00 to 17.00 on Thursday

8.30 to 17.00 on Friday

The practice was opening some Saturday mornings.

Out of hours the practice provided contact information for an emergency helpline and the patient will be seen in 48 hours in the Somerset area.

We carried out an announced, comprehensive inspection 4th October 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 16 comments about the practice. The practice received an average of 4.5 stars. The organisation responded to all the comments and offered to follow up any outstanding issues with patients who responded.

For this inspection 7 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 helpful and friendly. Patients told us that the practice was clean and hygienic. We received two negative comments that there was a long wait for available appointments.

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 was recruiting more dentists.

• 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.

The two requirements from the previous inspection had been addressed.

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 arrangements for the storage of oxygen so that there is a suitable sign to show where a hazardous substance is being stored.

We carried out an announced comprehensive inspection on 19 August 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 not 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 not providing well-led care in accordance with the relevant regulations.

Background

Mydentist – Town Street – Shepton Mallet is located in Shepton Mallet, Somerset. They provide general NHS dentistry to adults and children including routine check ups, root canal treatment, extractions, crowns, bridges and oral hygiene. Patients could be seen privately or through the NHS. Approximately 98% of patients receive NHS treatment with a 2% private patient base.

The practice has four treatment rooms, a decontamination room (for cleaning and sterilising dental instruments) and a dedicated Orthopantomogram (provides a view of all the teeth and supporting structures) X-ray room. The practice is purpose built, one treatment room is on the ground floor, which is fully accessible for patients with poor mobility. There are three treatment rooms on the first floor. The premises include an accessible toilet and two waiting areas; one on the first floor and one on the ground floor. Patients are greeted by reception staff at the entrance of the practice on the ground floor.

The staff structure comprises of four dental practitioners, two registered dental nurses (one of these was moving practices within IDH limited on the day of our inspection) and three trainee dental nurses. The practice currently does not have a hygienist. There is a reception administration team comprising of two receptionists per shift.

The practice is open from 8:30am until 7pm Monday and Tuesday and from Wednesday to Friday from 8:30am until 5pm.

We have a record of a registered manager in place. However they left their role in March 2015 and at the time of the inspection we had not received an application to cancel their registration. 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.

We spoke with four patients during the inspection who provided feedback about the service and we received 11 Care Quality Commission comment cards from patients. Patients told us they were seen quickly for urgent treatment, dentists had put them at ease when nervous and patients felt the treatment received was good with staff being helpful and respectful.

Our key findings were:

• The practice had systems and processes in place which ensured patients were protected from abuse and avoidable harm.
• Patients’ care, treatment and support achieved good outcomes, promoted a good quality treatment and was based on the best available evidence.
• Staff involved, and treated, patients with compassion, kindness, dignity and respect.
• Services could be improved to ensure they meet patients’ needs and reduce risks to patients, including regular consistent auditing of their practice and following provider procedures and protocols.
• Staffing arrangements need to be improved including regular appraisals and training. Recruitment processes need improving to ensure patient safety.

• Patients reported good access to the practice with emergency appointments available the same day.

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

• Ensure audits are fully completed regularly as specified by the department of health HTM01-05 guidance. Audits need to be completed by staff who have been sufficiently trained in areas including infection control to ensure the safety of patients using the service.
• Ensure there are effective communication systems to ensure policies and procedures were implemented effectively. For example, cleaners not following the providers cleaning schedule and clinical audits not being completed at intervals directed by the provider.
• Ensure staff support is provided through appraisals for all staff at regular intervals according to the provider policy.
• Ensure there is an effective system to monitor staff training to ensure it remained up to date and could be consistently monitored.
• Ensure the newly employed staff are recruited following the providers policy and information as specified in schedule 3 of the Regulations. This includes gaining appropriate references and criminal record checks before the person starts employment.

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:

• Monitor staff to ensure they understand the complaints procedure and can direct patients to this when they are raising concerns about the service received.

We spoke with five people who were receiving treatment on the day of our visit. They all told us they were very satisfied with the treatment they had received. One person told us, “I am really pleased I came here. They have given me lots of good hints and tips about looking after my teeth. They explain everything and make you feel so relaxed”.

We asked people if they always received enough information about their treatment. They all told us they had a treatment plan which they signed. We looked at some of these and noted that they had all been signed and this acts as consent for the treatment. One person did tell us that they were not always clear about what to expect when coming to the dentist. They said they felt they had to prompt the dentist. They knew about the bands of treatment. We discussed this with the practice manager. They told us people are told about what they can expect but are not given anything in terms of written information. We noted on looking around the waiting room that there was information about what people could expect to receive as part of their treatment particularly about frequency of check ups and the national health and private costs of treatment.

Another person we spoke with told us they were, “very happy” with the treatment. They said the dentist had asked them about pain relief and that they were, “always treated with respect”.

We spoke with five members of staff. They told us they had all received training in resuscitation and first aid. They had also undertaken child protection and adult protection training. We asked them about what they would do if they had concerns about a child or adult and they told us they would report it to their line manager or one of the dentists. We also asked them what they considered the principles of good decontamination practice. They told us about always wearing the necessary protective clothing such as gloves and eye mask, following the correct procedure when washing instruments and using equipment.

We asked staff about the support they received to do their job. They told us the practice manager was, “very approachable”. They also said they received three monthly reviews and monthly staff meeting but could always go to their manager if they needed to discuss anything. They said they all worked, “as a team”. They said they always worked as far as possible with the same dentist and this was good because of consistency for them as professionals and for patients, “we get to know our patients which helps make them feel comfortable coming to the dentist”.