One of the patients we spoke to said they had not visited a dentist for a long time and they were very nervous. This person said, “The dentist is fantastic, I was made to feel really comfortable.” Patients told us they were happy with the level of service and care offered and that they were given information about their treatment and knew what to expect. Another patient told us “I get good advice from the dentist and he tells me before he does anything.”

Staff members told us they felt they had appropriate facilities; equipment and resources to always meet their patient’s needs. They were happy working within the service and felt they all worked well as a team and were supported through discussion and training. They told us this enabled them to provide a safe and appropriate service to the people using the dental practice. One of the staff members we spoke to said, It’s really good, I love it.”

We looked around the dental practice and found that everywhere appeared clean. There were effective systems in place to reduce the risk and spread of infection.

Practices and procedures were in place for assessing and monitoring the quality of the service on a regular basis. This included regular audits being carried out with regards to infection control and hygiene, emergency drugs supply, checks on equipment and cleanliness and infection control.

We undertook a follow-up focused inspection of Signature Smiles – Warrington on 23 October 2018. This inspection was carried out to review in detail the actions taken by the provider to improve the quality of care, and to confirm that they were now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Signature Smiles - Warrington on 28 June 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive?

• Is it well-led?

We found the provider was not providing well-led care, and was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Signature Smiles - Warrington on our website www.cqc.org.uk.

When one or more of the five questions are not met we require the provider to make improvements. We then inspect again after a reasonable interval, focusing on the areas in which improvement was necessary.

As part of this inspection we asked:

• Is it well-led?

Our findings were:

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we identified at our inspection on 28 June 2018.

Background

Signature Smiles - Warrington is in the centre of Warrington and provides NHS and private dental care for adults and children.

There are steps at the entrance to the practice. Access can therefore be difficult for people who use wheelchairs and for those with pushchairs. Car parking spaces are available near the practice.

The dental team includes three dentists, one of whom is the principal dentist, two dental nurses, and one receptionist. The team is supported by a practice manager / compliance manager who is also a qualified dental nurse, and an area manager. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist. 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.

During the inspection we spoke to two dentists, a dental nurse, and the area manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 8.30am to 5.00pm.

Our key findings were:

• The provider had medical emergency medicines and equipment available which reflected recognised guidance.
• The provider had improved their systems for assessing, monitoring and reducing risks at the practice.
• The provider had improved their recruitment procedures and completed the necessary employment checks on staff, including Disclosure and Barring Service checks where appropriate.

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

• Review the practice's complaint handling procedures to ensure all the necessary information is available for patients to enable them to complain to other organisations should they wish to do so.
• Review the system for checking the expiry dates of all the medical emergency medicines in the practice taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.