We carried out an announced comprehensive inspection on 30 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

Oadby Dental Clinic is a dental practice providing private and NHS care for adults and children. Where private treatment is provided some is under a fee per item basis and some under a dental insurance plan. The practice is situated in a converted residential property with patient facilities on the ground and first floor.

The practice has three dental treatment rooms; two on the ground floor and one on the first floor. There is also a reception and waiting area, X-ray room and decontamination room on the ground floor, a further waiting room on the first floor and other rooms in the practice used by the practice for office facilities and storage. The practice is open from 9.00am to 6.00pm from Monday to Friday and by appointment on Saturday mornings. The practice closes for lunch from 1.00pm to 2.00pm.

The practice has two full time dentists and one part time dentist who are able to provide general dental services including endodontic (root canal) treatment, implants and cosmetic dentistry. They are supported by one dental nurse, two full time and two part time trainee dental nurses, a receptionist and a practice manager/receptionist.

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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience. We received feedback from a total of 46 patients. All of the feedback was positive with patients describing the care they received as second to none and commenting that the staff are professional, welcoming, reassuring and helpful. Patients also commented favourably on the cleanliness of the practice.

Our key findings were:

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

• Patient services were available on the ground floor of the building and were wheelchair accessible.

• Routine dental appointments were readily available, as were urgent on the day appointments and patients told us it was easy to get an appointment with the practice.

• Patients commented that they were highly satisfied with the care they received and commented on the helpfulness of the staff. They told us treatment options were explained to them and they were involved in decisions about their treatment.

• The practice did not have a clear system to identify, investigate and learn from significant events and there was a lack of staff awareness regarding the process.

• There was not an effective system to manage safety alerts but the provider told us they would review this following our inspection.

• National guidance was not always followed in respect of clinical record keeping and we found that rubber dams were not consistently used for root canal treatment.

• The practice was visibly clean and well maintained and we found that infection control procedures were 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.
• The practice had medicines and equipment for use in a medical emergency which were in accordance with national guidelines with the exception of glucagon that was not being stored appropriately but the provider rectified this during our inspection.

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

• Governance arrangements were in place for the smooth running of the service. However we found that protocols were not always followed and a number of policies required updating or introducing. Whiles some risks had been assessed, not all had been assessed comprehensively, such as the risk assessment relating to fire. Some other risks had not been assessed such as the risks relating to sharps handling and substances hazardous to health.

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

• Review its 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 practice protocols in respect of the use of rubber dam for root canal treatment and the maintenance of dental care records regarding clinical examinations and record keeping giving regard to national guidance.
• Review its referral processes to ensure urgent referrals are followed up and monitored.
• Review governance arrangements to ensure all risks are assessed, monitored and mitigated.

• Review the practice’s arrangements for receiving and responding to patient safety alerts.

• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurances and,ensuring that imporvements are made as a result.

• Review the practice’s sharps procedures giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.

We spoke with five people who were using the service during our visit. This enabled us to gather their thoughts on both the treatment they had received and the dental practice in general. They told us that they had been given the opportunity to decide what treatment they received and they were all very satisfied with how they had been treated. One person told us: "It is excellent, the best one I’ve been too, they are all very pleasant.”

There were systems in place to reduce the risk and spread of infection. Infection prevention and decontamination policies were in place and we observed one of the dental nurses carrying out the decontamination of instruments used during surgery. The dental nurse completed the decontamination process in line with the recommended guidelines set by the Department of Health.

The people who used the service told us that the practice was always clean and tidy and confirmed that the dentists and the dental nurses always wore protective clothing when providing their treatment. One person explained: “It is always so nice and clean.”

The recruitment process in place ensured that a check with the Disclosure and Barring Service (DBS) was carried out for each member of staff. This checked satisfied the provider that they were suitable to work at the service.

A monitoring and auditing system was in place to monitor and assess the quality of service being provided, though not all aspects of this were being formally recorded.