We carried out an announced comprehensive inspection on 5 December 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

Noble Dental Practice has two dentists, (the principal dentist and an associate dentist), two part time dental hygienists, one of whom is a newly qualified foundation hygienist (The practice has been approved by the regional postgraduate deanery to provide education and supervision to foundation hygienists/therapists), a qualified dental nurse who is registered with the General Dental Council (GDC), two trainee dental nurses and two receptionists.

The practice’s opening hours are 8am to 5pm on Monday and Tuesday, 9am to 5.30pm on Wednesday and Thursday and 9am to 1pm on Friday. The practice is closed for lunch each day between 1pm to 2pm.

Noble Dental Practice is a general dental practice offering treatment to adults and children funded by the NHS or privately. The practice has two dental treatment rooms on the ground floor and a reception and waiting area. There is a separate decontamination room for cleaning, sterilising and packing dental instruments.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 received comments from 18 patients by way of comment cards which were available at the practice for the two weeks prior to our inspection.

Our key findings were

• The practice had not developed systems for the recording and learning from significant events and there was no policy available to guide staff although they did have an accident book.
• Staff had received training regarding safeguarding vulnerable adults and child protection and were aware of the procedure for reporting any suspicions of abuse although contact details were out of date on some information seen.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients were treated with dignity and respect.
• The practice was visibly clean and well maintained.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Infection control procedures were in place with infection prevention and control audits being undertaken on a six monthly basis. Staff had access to personal protective equipment such as gloves and aprons.
• The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• Staff had been trained to deal with medical emergencies.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Policies and procedures were available to guide staff, although not all contained a date of implementation or review.
• The practice was well-led and staff felt involved and worked as a team.

There were areas where the provider could make improvements and should

• Review the systems in place to record, investigate and learn from incidents that occur in the practice.

• Review the practice’s policies, procedures and risk assessments; to ensure that a date of implementation and review is recorded, out of date information removed to avoid confusion for staff, reference is made to the Mental Capacity Act in the practice’s consent policy and the practice’s sharps procedure should be reviewed to ensure that due regard is given to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the systems in place for checking equipment to be used in a medical emergency to ensure the practice are giving due regarding to the guidelines provided by the Resuscitation Council (UK).

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

• Review the practice’s audit protocols at regular intervals to help improve the quality of service. For example radiography and dental care records audits and ensure that all audits have documented learning points which are shared with relevant staff and the resulting improvements can be demonstrated.

During our visit we spoke with two dentists and one dental nurse. We looked at the records for four people who had used the service. We observed treatment and spoke to one person at the practice on the day we visited. Following our visit we spoke with five people over the telephone, so that we could gain people’s views of the service provided.

People we spoke with had no concerns about the care and treatment they had received from their dentists. They told us “The dentist I see is good” and "The dentist is wonderful they explain everything to you and make you feel comfortable".

We found that people received the care and treatment they needed. We saw records detailed the treatment people received. People told us that they can get an appointment quickly in an emergency.

During our visit we saw that the surgery was clean and well organised. People we spoke with told us that the surgery was always clean one person said " The practice is clean and staff always look very clean and smart".

People told us that the staff were friendly and helpful. We saw that systems were in place to support staff in their role.

There were systems in place to monitor how the practice was run. This ensured that people received a quality service.