We spoke to four patients, three of whom were very complimentary about the practice. They felt that they were treated with respect and dignity. They told us that they were informed about the choices, costs, alternatives and possible outcomes of their treatment. One patient told us "They are very friendly - excellent" and another said "Excellent practice - the staff are very polite indeed". However, one patient felt that they did not get sufficient choice and was concerned about how quickly they were examined. On discussion with the practice manager the concern was noted, and they stressed that this would be raised at the next practice meeting.

We saw from the comment questionnaires that we looked at that patients were in general very happy. One comment stated "What a wonderful goodwill gesture, to come out late on Christmas Eve" relating to a dentist re-opening the practice to attend to the son of a patient, who was in pain.

The practice was friendly, welcoming and informative. We saw that patients were listened to in all areas of the practice. The surgery was clean throughout and there was evidence of a well-supported staff.

We found that all patients were given sufficient information to give an informed consent, and the staff were well trained and caring. The practice was well led by the practice owner and the staff were observed to be well organised.

We carried out an announced comprehensive inspection on 21 July 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

Royal Terrace Dental Practice is a dental practice providing NHS and private treatment for both adults and children. Treatment included a referral service for oral surgery and treatment under conscious sedation for patients who were very nervous undergoing surgical treatment. The practice is based in an adapted domestic dwelling situated in Dorchester, a town in Dorset.

The practice has five dental treatment rooms. Two of which are based on the ground floor and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The ground floor is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs five dentists, one hygienist, five dental nurses, two assistant practice managers and a practice manager.

The practice’s opening hours are between 8.30am and 5pm from Monday to Friday and 8.30am until last patient seen on Saturday.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

The practice manager and principle dentist are the registered managers. 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 obtained the views of 42 patients on the day of our inspection.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Effective leadership was provided by senior clinicians and a trio of empowered practice managers.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• Conscious sedation was carried out in accordance with current guidelines.
• 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.
• Staff received training appropriate to their roles and were supported in their continued professional development (CPD) by the company.
• Staff we spoke with felt well supported by the senior clinicians and practice managers and were committed to providing a quality service to their patients.
• Information from 47 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:

• Provide an annual statement about the practices’ infection control systems and processes giving due regard to the Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections” and related guidance.
• Review the risk assessment relating to fire safety including the maintenance of emergency lighting, fire alarms, fire drills and fire signage.
• Review the current system of providing hearing loops for patients who are hard of hearing.
• Review the patient toilet facility to include the addition of an alarm cord for patients in case of an emergency.
• Review the complaints procedure to include a specific time for the resolution of patient complaints.
• Review the system of capturing patient feedback to include a wider range of patient satisfaction criteria.
• Review staff meeting arrangements to enable dentists to attend.