We carried out an announced comprehensive inspection on 28 February 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

Norton Dental Practice (Mr E Kara provides mainly NHS dental treatments to patients of all ages but also offers private treatment options). The provider, Mr E Kara is one of two dentists who work in the same building under a separate registration with the Care Quality Commission (CQC). Some of the facilities and staff are shared between each practice located in the building. For example the practice manager, receptionist, reception area, toilets, staff room, waiting area and decontamination facilities are used by both dental practices under an expense sharing agreement. This report will make references to Norton Dental practice but this inspection only relates to the services provided by Mr E Kara.

Norton Dental Practice has three dentists (including the principal dentist), a part-time dental hygienist, two qualified dental nurses who are registered with the General Dental Council (GDC), a receptionist and a practice manager. The practice’s opening hours are 8.15am to 4.30pm on Monday to Thursday and 8.15am to 1.15pm on Friday.

The practice has two dental treatment rooms on the ground floor. Sterilisation and packing of dental instruments takes place in a separate decontamination room. There is a reception with adjoining waiting area on the ground floor.

Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice. We received comments from 6 patients by way of these comment cards and during the inspection with spoke with two patients who gave positive feedback about the practice.

Our key findings were

• Systems were in place for the recording and learning from significant events and accidents although records seen were not always fully completed.
• 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.
• Infection control procedures were in place and staff had access to personal protective equipment such as gloves and aprons.
• There was appropriate equipment for staff to undertake their duties.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Staff had been trained to deal with medical emergencies and the provider had emergency equipment in line with the Resuscitation Council (UK) guidelines.
• Local rules were available in all of the treatment rooms where X-ray machines were located and records were available to demonstrate that testing of X-ray equipment had been completed as required.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Governance systems were in place although required review to address issues identified during this inspection. For example not all actions identified in the fire risk assessment had been addressed, the practice had previously not completed annual appraisal of staff or infection prevention and control audits. The practice had recently purchased standardised policies, risk assessments and audit documentation and were in the process of adapting some of these to meet the needs of the practice.
• Staff told us that there were clearly defined leadership roles within the practice they felt supported, involved and they all worked as a team.

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 systems for assessment of risk and audit protocols; demonstrating action taken to identify any risks identified. For example the fire risk assessment and legionella risk assessment. Review audit protocols to document learning points that are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.

• Review systems for the maintenance of dental until water lines and provide evidence that the practice are 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 systems for ensuring dental materials are in date and fit for use.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and Gillick competency and ensure all staff are aware of their responsibilities.