We carried out an announced comprehensive inspection on 2 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

The Ramsey Dental Surgery provides primary dental care and treatment to patients whose care is funded through the NHS and to a small number of patients who pay privately. The practice is a well- established family partnership that employs two dentists, three specialist oral hygiene dental nurses, three other dental nurses, a practice manager/receptionist and an accounts manager/receptionist. The practice opens from 9am to 6pm Monday to Thursday and from 8am- 4pm on Fridays.

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 thirteen patients either in person or on CQC comments cards from patients who had visited the practice in the two weeks before our inspection. The cards were all positive and commented about the caring and helpful attitude of the staff. Patients told us they were happy with the care and treatment they had received.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Staff had been trained to handle emergencies and life-saving equipment was readily available in accordance with current guidelines. Emergency medicines were available in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• Infection control procedures were in place although systems followed in relation to clinical waste management and the storage of instruments required a review.
• The practice appeared clean although treatment rooms were cluttered and some were in need of refurbishment.
• Staff received training and development and were appropriately supervised.
• Patients told us they were able to get an appointment when they needed one and the staff were kind and helpful.
• Governance arrangements were in place for the smooth running of the practice. This included the completion of regular audits to help monitor the quality and safety of the service.
• The practice had recently started to develop a register of patients with a learning disability to recognise their individual needs and ensure they experienced appropriate appointments.

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

• Review the security of prescription pads in the practice and ensure there are system in place to monitor and track their use.
• Review the practice’s protocols for the use of rubber dams for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review and document a refurbishment plan for the treatment rooms so that the risks of spreading infection are minimised giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the procedures for storing sterilised dental instruments are in accordance with Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review the practice’s waste handling policy and procedure (including sharps waste) to ensure waste is segregated and disposed of in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01) and the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review and further develop the environmental risk assessments so that all documentation is up to date and guides staff in how to minimise the risks. Review the risks of cross contamination from the use of reusable protective bibs.
• Review the referral procedure so that all of these patients are routinely offered a copy of their referral letter.
• Review the practice's recruitment policy to include specific guidance on obtaining references. The policy should also include guidelines to risk assess which staff roles require a disclosure and barring service check.
• Review the process for documenting and sharing learning points following audit so that the resulting improvements can be demonstrated.

We spoke with eight people who the dentist services both before and after they had received treatment. They told us that they were happy with the treatment they received and felt they were given enough information about any proposed treatments. People advised that they were not familiar with the surgeries complaints procedure.

Most people had been visiting the same surgery for years and had other members of the family attending the same surgery. Some people had travelled quite a distance to stay with the same dentist who had moved from their previous practice.