We carried out this announced inspection on 16 October 2017 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.

We told Healthwatch that we were inspecting the practice. They did not provide any information.

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

Smile - The Gentle Dental Centre is in Exeter and provides private treatment to patients of all ages.

There is ramp access for people who use wheelchairs and pushchairs. Car parking spaces, including spaces for patients with disabled badges, are available at the practice.

The dental team includes six dentists, sixteen dental nurses, two dental hygienists, a governance administrator, a practice manager and a receptionist. The practice has four treatment rooms.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. At the time of the inspection the practice did not have a registered manager in post but CQC had received an application to register a candidate.

On the day of inspection we collected 46 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, one dental hygienist, the management team (partners, practice manager and governance administrator) and dental nurses, reception staff on duty. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 8am – 6pm. Tuesday 8am – 8pm. Wednesday 8am – 8pm. Thursday 8am – 6pm. Friday 8am – 4pm.

Our key findings were:

• The practice was clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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 personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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

• Review the arrangements for managing infection control processes in the decontamination rooms taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review the practice’s protocols for conscious sedation, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

This was the practice’s first inspection since dental services were required to register with the Care Quality Commission. During our inspection we checked and were assured that people using the dental practice had access to examinations in private. We asked people how they were involved in their treatment planning and whether they were invited to give feedback about their experiences. We met and spoke with staff and checked records. We found that patient and staff records were completed well. We toured the premises and were satisfied that people received safe and effective treatment in a clean environment.

Following the visit we contacted, with their permission, people who had attended the practice the week preceding our visit. We received replies from six people using our email questionnaire. People who responded to our questionnaire expressed high levels of satisfaction with the practice. Comments included;

•‘I feel relaxed and confident about my received treatment and about the level of hygiene.’

•‘I have been visiting Smile since they opened ten years ago and have never had cause to complain or even grumble. The staff will always answer questions and queries.’

•‘If they recommend special treatment then they provide me with a written estimate showing what teeth are affected and what they are going to do. I think it’s clear and comprehensive.’

• ‘Friendliness of the staff, lovely environment, comfy sofas, all add together to create a safe and secure feeling.’