We carried out this announced inspection on 29 June 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

Stuart Ralls Dental Practice - Gentle Dental Care Chippenham is in Chippenham, Wiltshire and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs.

The dental team includes a dentist, a dental nurse, two receptionists and a practice manager who is also a trainee dental nurse. The practice has a treatment room, a decontamination room and a reception area. The practice is open Monday to Thursday 8:30am – 5:00pm, one Thursday per month 8:30am – 7:30pm and alternate Fridays 8:30am – 1:00pm.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 26 CQC comment cards filled in by patients.

During the inspection we spoke with a dentist, a dental nurse and the practice manager who is also a trainee dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff 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 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.
• 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 protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.
• Review the Accessible Information Standard to ensure people who have a disability, impairment or sensory loss get information in a format that they can access and understand.

People spoke positively about their experiences and were happy. Staff were positive about working there. Information was available about the range of treatments on offer. People were consulted about the treatment options and a treatment plan was provided. Peoples medical history was checked at each appointment and they signed to give consent to treatment.

The staff at the practice were friendly and helpful to people attending appointments. Access was made easier for people because a ramp and handrail had been installed at the entrance to the practice. There were a range of treatments available and suitable arrangements for the taking of x-rays. Staff were trained to deal with medical emergencies and appropriate medicines were held in the practice to enable them to respond to emergencies. They had also been trained in safeguarding vulnerable adults and child protection. There were good arrangements for infection control and decontamination of dental instruments.

Staff were supported. Meetings were held and records of the meetings were kept. The dental nurses were undertaking formal training and the dentist maintained Continuing Professional Development through attending lectures and completing e-learning.

The practice conducted satisfaction surveys periodically and we saw the results of these were positive. General audits of the practice were carried out in addition to specific audits for relevant areas of work including infection control, x-rays and records.