We carried out an announced comprehensive inspection on 22 March 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 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

Pomfret Duncan & Singh provides mostly NHS dental treatment to adults and children. It also provides a number of additional private treatments such as cosmetic crowns and tooth whitening.

The practice has four dentists working a variety of clinical sessions over a week. The dentists are supported by dental hygienists and dental nurses. A practice manager and receptionists completed the team. The practice opens from Monday to Thursday between 8am and 5pm. Appointments are available between 8.30am and 12.30pm; and between 2pm and 5pm each day.

Emergency appointments are available each day.

The principal dentist 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.

We received feedback from 41 patients via CQC comment cards, this feedback was very positive about the care and treatment received from all staff within the practice.

Our key findings were:

• The practice recorded and analysed significant events and cascaded learning to staff.
• Complaints and concerns were handled informally and were not used as an opportunity to learn.
• There were effective systems in place to reduce the risk and spread of infection.
• There were limited systems in place to check all equipment had been serviced regularly.
• Staff had received some basic safeguarding training and knew the procedures to follow to raise any concerns. This training was not to the standard expected of dental professionals.
• Patient’s care and treatment was planned and delivered in line with evidence based guidelines; however not all new guidance was being implemented.
• The practice ensured staff maintained the necessary skills and competence to support their professional registration, but other training for example the Mental Capacity Act had not been made available. Staff had not received an annual appraisal.
• The recruitment policy was not always being followed. Appropriate checks were not carried out when new staff were employed.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available. However records were not maintained in respect of the checks carried out for this equipment to ensure that it was working properly.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity, respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• Governance systems required updating to ensure that appropriate monitoring of the services provided were carried out to improve quality and safety.
• The practice did not have a programme of continuous clinical and internal audit in order to monitor quality and make improvements.
• The practice sought feedback from staff and patients about the services they provided. 

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

• Ensure patients' safety is protected by using rectangular collimation during radiation.
• Review the arrangements for staff training so that it includes role specific safeguarding children training, Mental Capacity Act 2005 and Gillick awareness training; and that staff appraisal is recorded.
• Review the staff files so that they include documentation in respect of the recruitment checks carried out.
• Make information in respect of complaints accessible to patients.
• Review the systems for monitoring the quality and safety of the services provided so that these include monitoring and auditing radiography, monitoring and checking equipment, learning from complaints and reviewing current guidance and imbedding this into practice.

We spoke with four staff who told us about how consent for treatment was obtained and how medical records were updated and stored. We saw five treatment records that were all signed by the person and dentist and they were up to date. We saw records for the repair and maintenance of all the equipment used for dental treatment at the surgery.

We found that dental care was provided according to people's assessed needs. The dental staff spoke with people who used the service prior to treatment to check if there had been any changes in their medical condition from the previous treatment and to agree the treatment to be provided.

We spoke with five people. They all told us they were content with the service. One person told us, “I have come here for many years. The service is very good.” Another person told us, “The staff are so helpful. They have fitted me in at short notice when I had toothache.”

There was a complaints procedure in place. The dental practice was clean and there was a cleaning schedule in place. We spoke with four staff who told us they had received training around safeguarding children and vulnerable adults.

People we spoke with told us that staff were polite, courteous and treated them well. People said that treatment choices, benefits, risks and costs were explained to them in a way that they understood to help them make informed decisions. One person said ‘’Everything is explained to me in terms so that I can understand, I never feel rushed or pressured.’’

People we spoke with told us that they always received the treatment that they expected. One person told us that they had been patients at the practice for 34 years. They told us that they found the dentists and staff to be welcoming and professional. One person told us, ‘’The dentist always takes time to explain everything to me in detail. That is very important to me.’’ People told us that treatments were ‘’Unrushed’’ and that dentists and staff always take time to discuss everything.