We carried out this announced inspection on 18 September 2018 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

Seven Fields Dental Health Centre Ltd is in Swindon and provides private treatment to adults and children. There are two services provided by two different providers at this location. This report only relates to the provision of general dental care and specialist services provided by Dr Patrick Holmes. An additional report is available in respect of the general dental care and orthodontic service which is registered under the provider Dr Dominic Killian.

There is level access for people who use wheelchairs and those with pushchairs. The building had been renovated to include a lift to the first floor to enable full access to the facilities for patients in wheelchairs. Car parking spaces, including provision for blue badge holders, are available in the dedicated practice car park.

The dental team includes four dentists one of whom is an implantologist, one specialist endodontist, one specialist periodontologist, three dental nurses who are also trained as receptionists, two dental hygienists, one receptionist, one building manager who is a qualified dental nurse and the practice manager who is a qualified dental nurse. The practice has four treatment rooms.

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 46 CQC comment cards filled in by patients. Without exception patients were positive about the quality of the service provided by the practice. They gave examples of the positive experiences they had at the practice and told us the practice team were professional, caring and always involved them with their treatment options.

During the inspection we spoke with the principal dentist, two dental nurses, one dental hygienist, the building manager 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 8.30am – 5.30pm

Tuesday 8.30am – 5.30pm

Wednesday 8.30am – 7pm

Thursday 8.30am – 5.30pm

Friday 8.30am – 3pm

Our key findings were:

• Strong and effective leadership was provided by the principal dentist, an empowered practice manager and the building manager. Staff felt involved and supported and informed us this was a good place to work.
• The practice appeared clean and well maintained.
• The provider had infection control procedures which mostly reflected published guidance. On the day of our visit we found that there was no system for checking the temperature for the manual scrub water. This was rectified during our visit.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of a paediatric ambu-bag which was immediately ordered. We found one medicine had not been stored in the fridge and the expiry date had not been adjusted to accommodate this. The expiry date was reduced in line with manufacturers guidance on the day of our visit.
• The practice had systems to help them manage risk to patients and staff. We found that the practice had not completed a five-year electrical fixed wire test, this was immediately scheduled following our visit.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Safeguarding contact details and flow charts were displayed in the practice manager’s office.
• The provider had staff recruitment procedures although staff identification was not held on personnel files. This was rectified following our visit.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The provider renovated and moved to this premises in 2007 to expand and accommodate specialist services such as endodontics, dental implants, periodontics and orthodondontics. This enabled patients to receive more advanced treatments in surroundings they were familiar with and reduced waiting times for these complex treatments.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider was providing preventive care and supporting patients to ensure better oral health. They routinely referred patients to their dental hygienists through a clear care pathway.
• The appointment system met patients’ needs. Patients could access treatment and urgent care when required.
• The practice asked staff and patients for feedback about the services they provided. Information from 46 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, professional and high-quality service.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

There were areas where the provider could make improvements. They should:

• Review the practice’s audit protocols to ensure infection control audits are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.

During our visit to Seven Fields Dental Health Centre Ltd we met with the provider, Mr Patrick Holmes and spoke with two practice managers, the dental nurse and a member of reception staff. We spoke with three patients.

All of the patients we spoke with were very happy with the dental treatment they had received. One patient said “it’s excellent. I’m very pleased with all the treatment and the way it’s been given. I feel totally confident and happy with him [the dentist]. I’ve never felt that he can’t solve a tooth problem”. Another patient said “the service is very good. Staff have a good chair-side manner and I’m made to feel comfortable. There is good communication and they are well staffed”.

Patients said they were involved in their treatment plans and their permission was sought before any treatment started. A patient said “I receive a full explanation. The cost is written down. They always seek informed consent. We have chatted through what the options are and then I have made a decision”. We saw records of signed treatment plans held on file.

Patients we spoke with told us the practice was always clean and tidy, one said “it’s newly refurbished, nicely equipped and clean”. We found current infection control guidelines were followed to reduce the risk of infection.

Staff told us they were supported to carry out their roles. We saw from training records staff received training specific to their job.

The practice operated a complaints procedure which was accessible to patients. There had been one complaint in 2014 which had been responded to in line with the practice’s policy. We saw the patients had received a full written response with a detailed explanation and have received a refund for their treatment.

We met with four patients. They told us they were pleased with the service provided. One person said that staff treated them “exceptionally well” and they “feel as though they are friends”. Two of the people we spoke with said they were “100% happy”. Others said they were happy with treatment and one person who said they were satisfied would be returning for other work to be completed.

We spoke with two people by telephone. They had each been attending the practice for a number of years and were happy with the service they received. They commented on the friendliness of reception staff, cleanliness of the premises and how they are given information in “layman’s terms” about the treatment they would be receiving.

One of the staff described Mr Holmes as a perfectionist adding that he “wouldn’t let anyone leave the practice if he was unhappy with the way their teeth looked”.