We carried out this announced inspection on 13 June 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 the NHS England area team and Healthwatch that we were inspecting the practice. Healthwatch did not supply any information. NHS England provided information regarding the NHS contract held at the practice.

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 Together Truro Health Park is in the city of Truro, Cornwall and provides NHS urgent care access services and out of hours dental services. It also provides, by referral complex dental treatments, such as special care and paediatric services, inhalation and intravenous sedation to patients living in Cornwall and the Isles of Scilly.

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

The dental team includes six dentists, six dental nurses, two decontamination room technicians, five call centre operatives, one receptionist, a clinical support facilitator, clinical governance lead, head of nursing and quality and a clinical director (who is a qualified dentist). The practice has four treatment rooms.

The practice is owned by a private finance initiative company 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. The registered manager at Smile Together Truro Health Park was the clinical director.

On the day of inspection we collected 27 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses, the clinical support facilitator, decontamination room technician, head of nursing and quality, two call centre operatives, one receptionist and the clinical director. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9am – 5pm and 5.30pm – 7.30pm as out of hours services. The practice is also open on Saturdays and Sundays 8.30am – 12.30pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• 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 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 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.

We identified an area of notable practice.

• The practice management team and staff were committed to providing access to dental advice and services to vulnerable groups that find accessing dental services difficult. Staff were offering dental access to local fishing communities and the homeless. This was planned in conjunction with a UK dental charity, funded by Smile Together Dental CIC and used a mobile dentistry van. People did not need an appointment when the van arrived in a location near to them and they were seen by a dentist and dental nurse to assess their dental needs, provide oral health advice and basic treatment, where necessary.

There was one area where the provider could make improvements. They should:

• Ensure the practice's recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, to ensure necessary individual risk assessments are in place for relevant staff.