We carried out an announced comprehensive inspection on 7 November 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Oasis dental care practice is situated in a converted domestic premises in an urban area. It has five dental chairs and specifically offers dental implants, a hygienist service and orthodontics. There are five dental consulting rooms, four on the first floor and one on the ground floor, an office, reception area and three waiting areas.

The practice had recently undergone a refurbishment inside however the outside still required attention. Since the refurbishment the practice had offered extended opening hours from 8am to 8pm allowing patients the opportunity to book an appointment at their convenience.

The premises had disabled access via the use of a ramp into the practice and facilites are accessible on the ground floor level.The practice had a car park available at the rear of the building and also on street parking near the practice.

The practice was open: Monday – Thursday 8.00am – 7.45pm, Friday 8.00am – 5.00pm and closed at weekends. Opening times and out of hours number can be found on the website and via the answer phone.

The practice had four dentists and an orthodontist who were supported by five dental nurses, four dental hygienists two reception staff and a registered manager.

All fees were displayed in information leaflets for patients available in the practice and NHS fees were displayed on the practice website and in the waiting areas of the practice. There were arrangements in place to ensure patients received urgent dental assistance when the practice was closed. These arrangements are displayed in the practice and on a telephone answering service.

The practice manager 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. The registered manager is also one of the three trained dental nurses in the practice.

Before the inspection, we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from three patients. In addition we spoke with four patients on the day of our inspection.

Feedback from patients was positive about the quality of care, the caring nature of all staff and the overall high quality of customer care. They commented staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained them so they could make an informed decision which gave them confidence in the care provided.

Our key findings were:

• We observed and were told by staff the practice ethos provided patient centred dental care in a relaxed and friendly environment.
• Leadership was provided by an empowered practice manager.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• Premises appeared well maintained inside, but the exterior required attention, and visibly clean. Good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation.

• There were systems in place to check all equipment had been serviced regularly, including the autoclaves and the X-ray equipment
• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Infection control procedures were mostly satisfactory but the dental nurses were not flushing the dental water lines between patients as recommended. The practice mostly followed published guidance.
• The practice had a safeguarding lead with effective processes in place for safeguarding children and adults and living in vulnerable circumstances.
• There was a process in place for the reporting of untoward incidents that occurred in the practice.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• Dentists used Loupes – these enable the clinician to have a magnified view of the operation site thus enabling greater accuracy of treatment.
• Digital radiographs were used to help explain necessary treatment to patients while in the chair.
• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required including early morning and evening appointments.
• Staff received training appropriate to their roles and were supported in their continuing professional development (CPD) by the company.
• Staff we spoke with felt well supported by the practice manager and were committed to providing a quality service to their patients.
• Information from three completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.

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

• Review the dental nurses practice regarding the flushing of dental water lines between patients to ensure it complies with essential standards.

• Review the storage arrangements for cleaning buckets and mops which were stored in the corridor.
• Review providing the dental hygienist with the support of an appropriately trained member of the dental team at all times.

Review the system for monitoring staff training with specific reference to self-employed staff.