We carried out an announced comprehensive inspection on 12 April 2016 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

Stukeley Dental Surgery is an established dental practice in Huntingdon. The service provides a range of dental services to NHS and private patients of all ages. The practice has it’s own small car park and is situated close to a small retail park with additional parking. The practice has three dental treatment rooms a reception area and waiting area on the ground floor although one treatment room has step access and may not be accessible to some patients with limited mobility.

The practice opens Monday, Tuesday and Thursday: 9 am to 5:30 pm; Wednesday: 9 am to 6:30 pm; Friday 9 am to 1pm. The practice sees private patients from 3:30 pm onwards. The practice is closed at the weekends. Two principle dentists run the practice with assistance from one part time dentist, a lead dental nurse/ practice manager, two dental nurses (one of whom is a trainee) and a receptionist who covers one day each week. The practice employs three dentists and one dental hygienist.

The lead nurse/ practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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. However, at the time of the inspection the registered manager had discussed her decision to discontinue as practice manager/registered manager with the principal dentists. There was no clear plan on how the management responsibilities would be covered.

We received feedback from 40 patients either in person or on CQC comments cards from patients who had visited the practice in the two weeks before our inspection. The cards were all positive and commented about the caring and helpful attitude of the staff. Patients told us they were happy with the care and treatment they had received.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained. However the practice did not have access to an automated external defibrillator.
• Accidents were investigated and appropriate action was taken. Staff had not identified any incidents or significant events. However, we found an incident that had been well managed was not reported as an incident so that learning and improvement opportunities could be taken.
• Dentists provided dental care in accordance with current National Institute for Care Excellence (NICE) guidelines.
• The practice appeared clean and free from clutter.
• Staff received training and development although the system for annual appraisal was not well established.
• Patients told us they were able to get an appointment when they needed one and the staff were kind and helpful.
• Staff we spoke with felt well supported by the senior staff and were committed to providing a quality service to their patients.
• Information from 46 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.
• A complaints process was in place although the practice had not received any complaints in the last two years.

There were areas where the provider could make improvements and should:

• Review staff training to include: first aid management so that at least one member of staff holds a current first aid at work certificate and review staff awareness of the requirements and their responsibilities under the Mental Capacity Act (MCA) 2005. The consent policy should also be reviewed.
• Review the availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team. This should include a risk assessment of the decision not to hold an automatic external defibrillator at the practice.
• Review the incident reporting system so that it is used effectively to prevent further occurences and ensure that improvements are made as a result.
• Review the recruitment process so that it is in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Check that systems are in place to support staff through clear job descriptions and regular performance reviews.
• Review the practice's protocols for completion of dental records having due regard for the guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping. This should include clear records of patient referrals.
• Review the procedures for the use of the X-ray equipment giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000 in relation to rectangular collimation to reduce the amount of radiation received by patients.
• Review the audit programme so that audits are completed regularly to help improve the quality of service. The practice should also check that all audits have documented learning points and the resulting improvements can be demonstrated.
• Review procedures in place to support staff through a performance management process.
• Review the fire risk assessment and mercury spillage policy.
• Review its responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.
• Review the systems in place to discuss quality and safety issues with staff so that learning and improvement is shared.

People told us that the staff had always been polite and respectful to them. They commented on how the dentists had re-assured them and consulted them about their treatment. We were told that they had been satisfactorily informed about the service and how much the cost of their treatment was.

One person said, "I am utterly satisfied and very pleased to be attending this dental practice. I have had some previous poor experiences with dentists, but this one is excellent. They explain all my treatment and the options I have".

Safeguarding policies and procedures were not adequate and safeguarding training to protect vulnerable adults from abuse had not been provided for staff.