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

Sevenfields Dental Health Centre is in Swindon and provides NHS and 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 orthodontic service provided by Dr Dominic Killian. Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. Orthodontic treatment is provided under NHS referral for children, except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment. An additional report is available in respect of the general dental care and specialist services which are registered under the provider Dr Patrick Holmes.

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 the principal dentist who is also an orthodontist, one dental nurse, one dental hygienist, one receptionist and the practice manager who is a qualified dental nurse. The practice has one treatment room.

The practice is owned by an individual who another provider within the building. The principal dentist Dr Killian has a 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 29 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 they had always received the best care and treatment.

During the inspection we spoke with the principal dentist, the dental hygienist 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 and an empowered practice 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 available in the treatment room.
• 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.
• 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 hygienist 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 29 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 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.
• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. Ensure all maintenance certificates are held on file.

During our visit to Sevenfields Dental Health Centre we met with the provider, Dr Dominic Killian and spoke with the dental nurse and a member of reception staff. We spoke with three patients and two patients’ parents.

All of the patients we spoke with were very happy with the dental and orthodontic treatment they had received. One patient said “he [the dentist] provides me with exactly the level of service I’m looking for. The check-up appointments are effective. He always explained the work that is required and the options. I feel well informed here. I’m exceptionally happy with the service, as is my family”.

Patients said they were involved in their treatment plans and their permission was sought before any treatment started. A patient said “I received an information leaflet to tell me everything about the orthodontic treatment. We read it through and we [child and parent] signed a consent form”. Another patient said “he [the dentist] explains the work and I’m always provided with a spread of options. I like to be well informed and I do feel very well informed here. As a family we feel well informed here”. Patients told us they signed consent forms to have treatments. We saw records of signed patient consent forms held on file.

Patients we spoke with told us the practice was always clean and tidy, one said “It’s really clean. Obviously things are cleaned all the time. The dentist changes his gloves and masks before he examined my sister”. 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. All staff received an annual appraisal and had a personal development plan with clear objectives.

The practice operated a complaints procedure which was accessible to patients. There had been one complaint in 2013 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.

There were no people attending for appointments on the day of our visit. We spoke with two people and the mother of a younger person by telephone.

One person told us they had transferred to the practice because they were dissatisfied with the service they received elsewhere. They said they were impressed with all aspects of this service making reference to the friendly staff who they described as “respectful”. Another person told us they felt the premises were “beautiful” and that they “very pleased” with the service.

The mother of the young person stated that she felt the young person received a “really good service”. They said they felt the premises were clean and referred to staff as friendly and talkative. They told us that they had moved away from the area but still attended the practice because the service was good and there was “nothing they would change” about the practice.