We carried out an announced comprehensive inspection on 25 October 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

Shephall Dental Surgery is a general dental practice situated in the Shephall area of Stevenage, Hertfordshire. The practice has four treatment rooms and occupies a converted house.

The practice provides treatment to adults and children funded either by the NHS or privately.

The practice has seven dentists, of which two are the joint principal dentists and two are foundation dentists. Foundation dentists are newly qualified dentists that embark on a year training scheme in practice where they are mentored and attend training days. The principal dentists both act as trainers for the foundation dentists.

The practice offers placement of dental implants. This is where a metal post or posts are surgically placed into the jaw bone and used to support a false tooth or teeth.

A dentist and dental nurse from the practice offer a domiciliary service whereby they visit care homes to attend to the dental needs of individuals who are unable to attend the practice.

The practice is open between 9 am and 6 pm Monday to Thursday and from 8 am to 2 pm on Friday. Out of houses patients are directed by the answerphone to a local practice that remains open until 10 pm, and beyond that to contact the NHS 111 service.

One of the principal dentists 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 patients that attend the practice by way of comment cards which were available at the premises for the two weeks preceding our visit. 13 people provided feedback in this way. Patients were overwhelmingly positive about the care and treatment the received at the service.

Our key findings were:

• The practice was clean and clutter free.

• Patients commented that staff were kind and professional and were able to put children at ease.

• A new patient appointment could be secured at the service within two to three days of contact.

• The pre-employment checks that were carried out on new staff met national standards; however references were not always recorded.

• Standards in infection control met nationally recognised standards; however the flooring in one treatment room was not sealed.

• The practice was not recording significant events which would provide an opportunity for learning.

• Policies were in place to assist the smooth running of the service, and although these were read and signed annually by all staff the policies were not dated to indicate when they were last reviewed.

• The practice had medicines and equipment available to treat medical emergencies. A duplicate kit was available to take on domiciliary visits.

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

• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.

• Review the ability to effectively clean areas of the practice with reference to the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices.’ published by the Department of Health.

• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded.

When we inspected Shephall Dental Surgery on 18 June 2013 we found that people were asked for their consent and the provider acted in accordance with their wishes. One person said, “I have to sign a consent form after they have told me what treatment I need and about the charges. I understand exactly what is going to happen.”

People's treatment was planned according to their needs and delivered in a way that was intended to ensure their safety and welfare. For example, a person told us, “I am a very nervous patient but they really put me at ease by explaining what the options were and the potential outcomes. I told them I would have difficulty with the x-ray and they were very understanding and helpful.”

We saw that the provider followed a strict decontamination cycle in accordance with Department of Health instructions. People were cared for in an environment that was clean and hygienic. One person said, “They are very clean and safe. They all wear gloves and aprons and masks. The nurse cleans the surfaces as they go along.”

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Clinical staff maintained records of their continuing professional development.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. Regular audits were carried out and people were asked for their feedback about the service.