We carried out an announced comprehensive inspection on 3 August 2015 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

CQC inspected the practice on 16 February 2015 and asked the provider to make improvements regarding legal requirements relating to cleanliness; infection control; recruitment processes and monitoring the quality of the service provided. We checked these areas as part of this comprehensive inspection and found they had been resolved.

The practice offers private comprehensive, preventative care and treatment for its patient population. High Street Dental Practice has three dentists and one visiting dentist, from another of the company’s practices, who offers the dental implant service. There is a practice manager, three dental hygienists, four dental nurses and two receptionists. At the time of our inspection there were three dentists supported by dental nurses on duty to meet the demands of the patient population. The practice manager was also in attendance.

The registered manager is one of the dental partners at the practice. 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.

The practice is open Monday, Tuesday, Wednesday & Friday: 8.30am – 5.00pm, Thursday: 9.00am – 7.00pm. As it is a wholly private practice it offers the company dental care plan – ‘Torplan Care Plan’ as a form of dental insurance and to assist with spreading payment for dental treatments. The service is closed at weekends but offers an Out of Hours service for those patients who have signed up to the Torplan - Care Plan.

We spoke with eight patients who used the service on the day of our inspection and reviewed 22 Care Quality Commission (CQC) comment cards that had been completed by patients prior to the inspection. The patients we spoke with were very complimentary about the service. They told us they found the practice and staff provided excellent and highly professional care; were extremely friendly and welcoming and all patients felt they were treated with dignity and respect.

We found the practice was effective in treatments provided, caring and responsive to patients needs and well led by the practice manager. We found the provider and manager had taken action to address the areas of non-compliance found at the last inspection.

Our key findings were:

• The practice had systems and processes in place which ensured patients were protected from abuse and avoidable harm.
• Patients’ care, treatment and support achieved good outcomes, promoted a good quality of life and was based on the best available evidence.
• Staff involved, and treated, patients with compassion, kindness, dignity and respect.
• Services were organised so they meet patients’ needs.
• The leadership, management and governance of the organisation assured the delivery of high-quality; patient centred treatment and care, supported learning and innovation, and promoted an open and fair culture.

• Patients reported good access to the practice with emergency appointments available the same day.

We visited High Street Dental Practice because we had received information of concern relating to a number of issues which included updating of medical records, security of patient records, informed consent, and infection prevention and control. We spoke with five patients and nine members of staff, including the Registered Provider and the principal dentist.

Patients we spoke with said they felt involved in decisions about their care and treatment. They told us the staff took time to explain their treatment options and they were given appropriate information and support regarding their care or treatment. Where appropriate patients had been given a written treatment plan which contained clear information about costs relating to their treatment.

The practice had a ramp that was used to enable wheelchair access over the one step into the practice. We saw and were told there were limited arrangements in place to communicate with patients whose first language was not English.

Care and treatment was planned and delivered in a way that was intended to ensure patient’s safety and welfare. The staff told us of their responsibilities to protect children and vulnerable adults and they were aware of who to contact if they had concerns. However staff had not received formal training in safeguarding procedures and no lead member of staff had been appointed.

The standard of general cleaning and maintenance in the practice was good. The cleaning equipment was stored appropriately and National Patient Safety Association (NPSA) guidance about cleaning the practice was followed. The patients interviewed told us they considered all aspects of the practice to be clean.

Staff told us they felt well supported and could seek advice or help at any time. They said, and we observed, there was very good team working. The staff told us “we get along really well”; “it’s a good team” and “we can ask anyone for help”.

Staff records and other records relevant to the management of the service were not always adequate. The provider did not have effective and consistent arrangements for monitoring and assessing the quality of service provided at the practice. Patient’s paper records were not kept securely although we observed the computerised records were secure as access was password protected.