We carried out this announced inspection on 14 September 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

Panshanger Dental Practice is in Welwyn Garden City and provides NHS and private treatment to patients of all ages.

The practice is undergoing major reconstruction. During this time the practice has redirected its patients with disabilities to another local practice where they have a reciprocal arrangement. Patients were consulted prior to the developments starting. There is level access for people who use wheelchairs and pushchairs. On street car parking spaces are available outside the practice; there is also a car park opposite the practice. The practice has developed the area outside the practice for staff car parking and a bicycle park, once complete this will include parking for patients with disabled badges.

The dental team includes three dentists, three dental nurses, two receptionists and the practice manager. During the reconstruction the practice has two functioning treatment rooms on the first floor; once the redevelopment is complete there will be five treatment rooms, three on the ground floor and two on the first floor.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 at Panshanger Dental Practice is the principal dentist.

On the day of inspection we collected 21 CQC comment cards filled in by patients and spoke with one other patient. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 8.45am to 5.30pm and alternate Saturdays from 9am to 1pm by appointment. The practice is closed between 1.30pm and 2.30pm daily.

Our key findings were:

• A strong and effective leadership was provided by the principal dentist and an empowered practice manager who had a clinical dentist background.
• The practice was clean and well maintained. At the time of the inspection the practice was undergoing major building redevelopment; however there were effective systems in place to ensure patients and staff were safe and there was minimum disruption to services.
• 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 with the exception of in date oxygen and a misplaced portable suction unit these were ordered promptly.
• 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.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current 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. Comments received from patients were wholly positive and where feedback had been given the practice had taken action.
• The practice dealt with complaints and compliments positively and efficiently.

When we inspected this dental practice in December 2013 we found several concerns in the way the provider managed the standard of cleanliness and infection control processes. We judged that these concerns had a moderate impact on people using the service and we asked the provider to take action to address them.

During our inspection we also identified concerns about how the provider supported staff at the practice and how the quality of services was measured. We judged that these concerns had a minor impact on people using the service. We also asked the provider to take action to address these concerns.

Following our visit the provider sent us an action plan in which they addressed the concerns we had identified.

On our follow-up inspection visit, in July 2014, we found that the practice had made improvements to the decoration and presentation of the premises. We saw that new cleaning schedules and infection control processes were in place and that these schedules were clear and up-to-date.

We also saw that policies and procedures for staff support, supervision and training had been reviewed and updated as required. We looked at staff files and saw that training, supervision and annual reviews had been put in place.

We found that a rigorous quality assurance system had been introduced. We saw that patients’ views about the service were actively sought and their comments were discussed at practice meetings.

We spoke with four people who used the service. People told us that the dentists explained the treatment options to them and explained the benefits and risks of each option. One person said, "I recently had a crown fitted. They went through the options and explained the pros and cons of certain materials."

People told us that they were very happy with the treatment they received. One person told us, "It is an outstanding service. I still come here even though I now live a long way away." We looked at the treatment record of seven people who used the service. These showed that people had been asked to complete a full medical history before they received treatment and that this was updated regularly. This ensured that the dentist could properly assess the risk of any treatment to the person's health and well-being.

During our inspection we found that the standard of cleanliness was not appropriate in all areas of the service. In two of the four treatment rooms we saw that there was no coving between the floor and the walls and cupboards. Dirt could easily accumulate in the gaps.

We spoke with two dental nurses and one of the dentists who told us that they did not have any system of supervision. The registered manager told us that there was a corporate appraisal system but this had yet to be introduced at the service.

We found that there was no system for regularly asking people who used the service for their opinions as to the quality of the service provided.