We carried out an announced comprehensive inspection on 31 March 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 is a Europe-wide dental care provider with a practice located on Victoria Street, in the Staple Hill district of Bristol. There is free parking on the nearby roads, and disabled parking bays provided in a courtyard to the rear of the practice. The practice provides mostly NHS dental treatment, to adults and children. It also provides a number of additional private treatments such as cosmetic crowns.

The practice employs three dentists, but currently no hygienists. The dentists are supported by three dental nurses, a practice manager who is also a qualified dental nurse, one trainee dental nurse, and two full-time receptionists. Following patient feedback, the practice changed its opening hours to better suit their needs. The practice is now open from Monday to Friday between 8:30am and 6.30pm; with extended opening on Tuesday until 7:00pm. 20-minute emergency appointments are available daily with each dentist at 11:00am and 3:00pm for the surgery’s own patients; and outside of normal hours via the 111 service.

The practice has rented the Victorian-era building since 2012. The premises consists of three dental treatment rooms, two on the ground floor, the other on the first floor; a staff room, patient waiting areas on both the first and ground floors; a decontamination room, and a staff room. Disabled access is to the rear of the building, and there is a ramp that spans the length of the garden, leading to the back door.

The practice manager is also the registered manager. 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.

During the inspection we spoke with three patients who used the service and reviewed 20 completed CQC comment cards. The patients were very positive about the care and treatment they received at the practice. Comments included that staff were helpful and thorough; and that the standard of dental care was excellent. They also commented that the practice was safe and hygienic, and that their concerns were listened to and addressed.

Our key findings were:

• We received consistently good feedback from patients about the quality of the practice’s staff and the effectiveness of their treatment.

• PPatients’ care and treatment was planned and delivered in line with evidence-based guidelines, current practice and current legislation. We saw patients’ dental care records that provided an accurate, thorough and up-to-date record of care.

• Infection control and decontamination procedures were robust.
• Patients received their care and treatment from well-trained and supported staff, who received regular appraisal and observation of their performance. Staff enjoyed their work citing good team relations, support and training as the main reasons.
• The practice sought suggestions from staff and patients and acted on these to improve the services it provided. However, feedback was not made available to patients to inform them of this.

• PPatients received clear and detailed advice about the costs, benefits and risks of their proposed treatment options; and were involved in making decisions about their care.

• TThere were effective systems in place for treatment documentation.

• SStaff had received safeguarding training and knew the processes to follow to raise any concerns regarding adults and children.

• TThe appointments system met patients’ needs.

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

• Review and update the identification of zones in the decontamination room to ensure that there is clear and unambiguous signage. This is consistent with section 2(5) of the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review the cleaning schedule so that the premises are cleaned more regularly, thereby giving due regard to the general hygiene guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review the mechanism for patient feedback, to ensure that information about improvements is relayed to the patients. This is consistent with the Public Sector Equality Duty of the Equality Act (2010), and the requirement to publish feedback.

We spoke with eight people who attended the practice during our visit. One person told us that all of their children were registered with the practice and had no problems attending. People told us they were happy attending the practice and found that the dentists explained what they were doing in “easy to understand language”.

People were complimentary about the cleanliness of the practice and comments were made about the friendliness of the staff. They said they were given good advice about tooth cleaning and oral health. Some told us they had recommended the practice to others.

We met one person who had an appointment for a tooth to be extracted. They said they had received “First class treatment from the reception staff to the dentist”. They told us they had been given an aftercare package with instructions and been told to return to the practice if they had any concerns.

We spoke with the dentists, dental nurses and reception staff. They were complimentary about the manager with one person describing them as “Top manager”. All of the staff said they felt supported and described the support they received from their colleagues and the good team working.

Information was available and people were consulted about treatment options. Records were maintained of the treatment people had. The provider made arrangements to protect people and there were good arrangements for infection control.

Staff received training and the provider monitored the service.

We spoke with three people who were attending the dental practice on the day of our visit, they all told us that they had no problems in making appointments. One person commented that the reception staff were very good. All of the people we spoke with told us that they were made aware of the costs of their treatment whether it was on the NHS or private. One person we spoke with told us that were very nervous of the dentist and this was their first appointment. They said “The dentist explained everything as he was doing the treatment.”