We carried out an announced comprehensive inspection on 28 March 2017 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 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

Specialist Dental operates from a converted commercial property and provides specialist and general dental care on a private basis. Specialist services include periodontics (gum treatments), orthodontics (straightening mal-aligned teeth and jaws), endodontics (root canal treatments), prosthodontics (the replacement of missing teeth) and oral surgery. The practice is situated in the town Guildford Surrey.

The practice has five dental treatment rooms of which four are in operation; two dedicated decontamination rooms used for cleaning, sterilising and packing dental instruments. The rooms are located over the ground floor and first floor level. The ground floor is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs seven dentists, six of whom are on the General Dental Council’s specialists list, one dental hygienist, three dental nurses, three reception staff and a business manager.

The practice’s opening hours are Monday to Wednesday 9am to 5pm, Thursday 11am to 8pm and Friday 9am to 4pm.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed.

As a condition of their registration with the CQC, the provider is required to ensure that the regulated activities are managed by an individual who is registered as a manager in respect of those activities at Specialist Dental. At the time of the inspection there was no registered manager in place. The provider told us that the previous post holder had left and the business manager was undertaking the role of the registered manager. They showed us evidence that they were currently in the process of completing the application process to have a new registered manager in place.

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.

Before the inspection, we sent CQC comments cards to the practice for patients to complete to tell us about their experience of the practice. We collected 31 completed cards. All the comments from patients were entirely positive about the care they received from the practice. They were complimentary about the friendly and caring attitude of the dental staff.

Our key findings were:

• We found that the practice ethos was to provide high quality specialist and general dental care in a relaxed and friendly environment.
• Effective leadership was provided by the principal partners and an empowered manager.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.
• Dentists provided dental care in accordance with current specialist professional and National Institute for Care Excellence (NICE) guidelines.
• The service was aware of the needs of the population they served and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• Staff received training appropriate to their roles and were supported in their continued professional development (CPD) by the providers.
• Staff we spoke with felt well supported by the management and were committed to providing a high-quality service to their patients.

We saw that people were asked for their consent before treatment was delivered. One person told us “The dentist always tells me exactly what they are about to do and make sure I’m happy for them to go ahead.”

Care and treatment was delivered in a way that promoted people’s wellbeing. The service kept accurate records of care and had ensured that there were plans in place to deal with emergencies which might reasonably be expected to arise.

The provider had ensured that the risk of abuse was minimised as they had ensured that staff had received appropriate training. The registered manager had ensured that information was available to staff and people who used the service. That information supported people to recognise abuse and report it appropriately.

The registered manager had procedures in place to ensure the risk of infection was minimised. There was also in place a series of audits to check the cleanliness of the service had been maintained. Staff had received appropriate training. One person told us, “I am always impressed by just how clean it is here.”

Complaints were dealt with according to the laid down procedure and the provider supported people to complain had they have felt the need to do so.

The registered manager had created and maintained a comprehensive set of records to ensure that all aspects of the service were monitored and maintained to a high standard. Those records were appropriately secured and were readily available when requested.