We carried out this announced inspection on 28 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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

Old Market Dental Practice is in Droitwich and provides private treatment to patients of all ages.

The practice is currently not suitable for people who use wheelchairs as there is a small step leading into the practice and the dental treatment room is located on the first floor accessed by stairs. The ground floor of the practice consists of a reception area, a waiting room and a patient toilet. On the first floor there is a staff room / office, a toilet and one dental treatment room with an area for decontamination for the cleaning, sterilising and packing of dental instruments. Car parking spaces, including spaces for blue badge holders, are available in the pay and display car park which is a short walk from the practice.

The dental team includes the principal dentist, two dental nurses who also work in reception and a practice advisor.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected seven CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the principal dentist, two dental nurses and the practice advisor. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday: 9.30am – 5.30pm

Tuesday: 8.30am – 5pm

Wednesday: 9am – 5pm

Thursday: 9.30am – 5.30pm

Friday: 9am – 1pm (one per month)

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Safeguarding flow charts containing local authority contact details were kept on file.
• The practice had thorough staff recruitment procedures.
• The principal dentist provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• Training and development was at the forefront in this practice due to the practice advisor being an accredited trainer and assessor.

When we arrived at The Old Market Court dental surgery we were met by the practice nurse who also undertakes the role of receptionist. During our time at the surgery we spoke to the practice nurse and the dentist.

In addition to people working at the practice we also spoke with a patient who was waiting for treatment. We spoke to five people who attend The Old Market Court Dental Practice on the telephone and received e-mails from a further two patients.

The people we spoke with were positive about the practice and appreciative of the care they received there. People told us that they had visited the dentist at the practice for a long time. Comments included “very very good”, “excellent”, “the service is exemplary”, “friendly personal service, very efficient and caring, I always get a service and advice that I can trust”. The dentist and dental nurse were described as “approachable, friendly and professional”. Most added that family members were also patients at the same surgery. People said that they do not usually have to wait long before the practice nurse comes into the waiting room and asks them to go up to the dentist.

People said that the practice was clean and that the dentist and nurse wore disposable gloves and aprons when providing their treatment. One person told us that they had seen the dentist using hand gel. Everyone we spoke with confirmed that they were given goggles to protect their eyes.

The surgery is split into two halves. Treatment is carried out in one half while the other half appears more like an office. The floor in the treatment area is washable while the office side is carpeted. The dentist said that changes to the current layout or alternative floor covering may be needed.

We asked the dental nurse to explain to us the decontamination arrangements. We were informed that heavy duty gloves and goggles were used when brushing debris from instruments. A magnifying glass with a light was provided and we were informed that this was used following washing and brushing to look for any debris not seen by the naked eye. Equipment was placed on to trays prior to going to into the newly purchased autoclave machine which was situated in the ‘office’ side of the room.

There was information about how to raise a complaint on the receptionist desk in the waiting area. We saw information about how to handle complaints in a file containing policies and procedures. Although no formal complaints have been received at the practice we were informed of two incidents and the actions taken to resolve these matters.

A list of the drugs held was attached to the front of the box holding these items. Inside the box we noticed a supply of aspirin. The expiry date on these drugs was October 2006, therefore making them over five years past their expiry date. The dentist assured us that he would not have used this medicine on a patient. Although a system was in place to monitor medication held it had failed to pick up that these tablets had passed their expiry date. The medication was immediately redrawn from the kit by the dentist and placed to one side for destroying.

We found both the dentist and dental nurse to be enthusiastic about dental care. In our conversations with these people we gained the impression of a committed and professional team who wanted to give people a good service.