We carried out this announced inspection on 2 May 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

Spadental Ledbury is located close to Ledbury town centre and provides private treatment to patients of all ages.

There is access available with a portable ramp for people who use wheelchairs and those with pushchairs. Car parking spaces are available on the opposite side of the road to the practice. Car parking spaces for blue badge holders are available in nearby pay and display car parks.

The dental team includes the principal dentist, two dental nurses (one of whom covers reception), a dental hygienist and the practice manager. The practice has two treatment rooms.

The practice is part of an organisation which includes two practices in Herefordshire. These are owned by the principal dentist. As a condition of registration the practices 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 Spadental Ledbury was the principal dentist.

On the day of inspection we collected 30 CQC comment cards filled in by patients and looked at recent patient satisfaction survey responses. This information gave us a positive view of the practice.

During the inspection we spoke with the principal dentist, two dental nurses 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: 9am to 5pm

Tuesday: 9am to 5pm

Wednesday: 9am to 5pm

Thursday: 9am to 1pm

Friday: 9am to 5pm

Our key findings were:

• The practice appeared 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, with the exception of a self-inflating bag with reservoir for a child and clear face masks (sizes 0, 1, 2 and 4). These were ordered and replaced the day after our inspection.

• The practice had systems to help them manage risk and had implemented comprehensive risk assessments, with the exception of a sharps risk assessment. We were sent a copy of the sharps risk assessment the following day.
• The practice staff 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 privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs. Patients could access routine treatment and urgent and emergency care when required at one of the two practices.
• The practice had effective leadership and culture of continuous improvement.
• 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 staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular by completing a sharps risk assessment and undertaking infection control audits on a six monthly basis.

We spoke with eight of the dentist’s patients either in person or by telephone. Four of these people mainly went to the Ledbury practice and four to the Ross one. Some of them also told us about the experiences of their partners or children.

People were pleased with the service they received at the practice. Everyone said that the dentist and the rest of the dental team were friendly. People made comments such as, “they are accommodating and friendly” and, “I couldn’t be happier”. People felt that they were given clear information about what treatment they needed and why. One person said their impression was that the dentist was, “very skilful and experienced”.

There was medication and oxygen available for certain medical emergencies. Staff were trained to know what to do if a person became unwell at the practice.

The practice was clean and people we spoke with told us they thought standards of cleanliness were very good there. There were suitable arrangements for the cleaning, sterilising and storing of instruments. Staff described these procedures to us confidently.

The dental team were qualified and maintained their continuous professional development (CPD) as required by the General Dental Council (GDC). The staff files contained clear evidence of this.

The practice had arrangements for monitoring the quality of the service and for assessing and reducing any risks to people using the service, or staff.