We carried out an announced comprehensive inspection on 9 January 2017 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

Natural Smiles is a dental practice providing private care for adults and children. Some treatment is provided under a fee per item basis and some under a dental insurance plan. The practice is situated in a converted modern property with all patient facilities on the ground floor.

The practice has two dental treatment rooms. There is also a reception and waiting area and other rooms used by the practice for office facilities and storage. The practice is open from 10.00am to 8.00pm on Mondays, 9.00am to 5.00pm on Tuesdays, 9.00am to 6.30pm on Wednesdays, 9.00am to 5.30pm on Thursdays and 9.00am to 5.00pm on Fridays.

The practice has one full time associate dentist and the principal dentist worked at the practice on a part-time basis. They are supported by two full time dental nurses, one of whom was also a treatment co-ordinator, a part time dental nurse, a practice manager and a dedicated full time receptionist.

The practice is able to provide general dental services including endodontic (root canal) treatment, short term orthodontic treatment, implants and cosmetic dentistry. The practice also provides the option of treatment under conscious sedation and the expected arrangements are in place to do this safely. Conscious sedation is the use of medicines to reduce alertness and help the patient relax but still be able to hear and respond to the dentist if necessary, while treatment is carried out.

The associate dentist is 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience. We also spoke with patients on the day of our inspection. We received feedback from 22 patients. All the feedback was positive with patients commenting favourably on the quality and personalisation of care and service they received, the professional and helpful nature of staff and the cleanliness of the practice.

Our key findings were:

• Staff reported incidents which were investigated, and learning implemented to improve safety.

• The practice was visibly clean and well maintained but we found that not all infection control procedures were not in line with the requirements of the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices’ published by the Department of Health. For example a lack of airflow in the decontamination room and the ultrasonic bath being overloaded.

• The practice had medicines and equipment for use in a medical emergency which were in accordance with national guidelines with the exception that glucagon was stored in an unmonitored fridge. We were advised following our inspection that this had been rectified.

• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).

• Patients commented that they were very pleased with the care they received and that staff were helpful, kind and courteous. They also commented that they were always able to get appointments in a timely way, including in an emergency.

• The practice had good facilities and was equipped to treat patients and meet their needs.

• Arrangements for the provision of treatment under conscious sedation were in line with published guidance.

• Governance arrangements were in place for the smooth running of the service. However we found that some policies required dating or a review date included.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum

01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• Review the practice’s audit protocols to ensure they are carried out at appropriate intervals and check all audits have documented learning points and the resulting improvements can be demonstrated.
• Review governance arrangements, including acting on recommendations of the fire risk assessment, ensuring policies are dated and reviewed and ensuring staff performance appraisals take place regularly.