We carried out an announced comprehensive inspection on 13 October 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

The Chequers Dental Practice is located near the city centre of Salisbury and provides mostly private dental treatments with approximately 10% of patients receiving NHS treatments. The demographics of the practice were mixed, serving patients from a range of social and ethnic backgrounds. The practice is open Monday to Saturday with a range of opening times including evening appointments. The practice facilities include three consultation rooms, reception and waiting area, decontamination room, X ray room, staff room and administration office. The premises are wheelchair accessible and have facilities for wheelchair users, except for an accessible toilet.

Services offered

• Preventive advice and treatment
• Routine and restorative dental care
• Root canal treatment
• Dental hygiene
• Surgical treatment
• Crown and bridgework
• Implants
• Restorative dentistry

• Orthodontic treatments

• The Chequers is the only practice in Salisbury to have a Cone-Beam CT scanner as 3D imaging is becoming increasingly important in diagnosis and treatment planning within implant dentistry, endodontic and orthodontics.

We received 46 completed Care Quality Commission comment cards and spoke with two patients during our inspection. Patient feedback was positive about the service. They told us staff were efficient, friendly and polite and always treated them with respect. They described the service as professional and working to an excellent standard. Information was given to them appropriately and staff were helpful to assist if needed.

The principal dentist is the registered manager. 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.

Our key findings were:

• The practice carried out oral health assessments and planned treatment in line with current best practice guidance, for example from the Faculty of General Dental Practice (FGDP). Patient dental care records were detailed and showed on-going monitoring of patients’ oral health.
• There were systems in place to help ensure the safety of staff and patients. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies.
• Staff were supported to maintain their continuing professional development; had undertaken training appropriate to their roles and told us they felt well supported to carry out their work.

• Patients commented they felt involved in their treatment and that it was fully explained to them. We reviewed 46 CQC comment cards completed by patients. Common themes were patients felt they received very good care in a clean environment from a helpful and professional practice team.

• The practice had an efficient appointment system in place to respond to patients needs. Patients were able to make routine and emergency appointments when needed. There were clear instructions for patients regarding out of hours care.

• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.
• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.
• The practice had an accessible and visible leadership team with clear means of sharing information with staff.

This inspection was undertaken to follow up on the serious concerns we identified at the last inspection on 14 January 2015. This led to the suspension of treatment at the service for 11 working days. At this inspection we found the provider had made significant improvements to the service and we lifted the suspension of service. We found the practice had met the minimum standards for safe provision of care and treatment to patients.

At this inspection we were accompanied by a specialist dental adviser. The practice had made good progress to address the concerns raised at the last inspection and had implemented most of the action plan supplied by the provider. The evidence gathered during this inspection demonstrated staff had a greater understanding of the principles and practices required to meet the regulations for the safety and well-being of patients.

During this inspection the provider demonstrated action had been taken to address the risks of unsafe care and treatment at this practice. We were told and saw the use of conscious sedation had been suspended to enable nursing staff to gain the skills and experience required to offer this service.

We saw the environmental risks and hazards had been addressed through refurbishment where necessary. We were told staff had received further training about the national guidance and standards for cleanliness and infection control. Staff spoken with demonstrated a greater awareness of this guidance and had taken steps to implement it. We saw they maintained the required records and had appropriate management and storage for dental instruments and clinical waste, which was handled in line with national guidance.

We saw the provider had taken some steps towards implementing systems to monitor the quality and safety of the practice for the well-being of patients. However we noted the provider was still working towards full implementation of systems to monitor safe practice for the well-being of patients. They told us they was being supported in this by an external company.

This inspection was undertaken following information of concern received from the General Dental Council about the quality and safety of care at this practice.

On the day of our visit we spoke with four patients who were complimentary about the practice. All felt they were treated with respect and dignity. All four patients told us they were informed about the treatment alternatives and possible outcomes of the treatment.

The practice had no disabled access and there were limited arrangements in place to communicate with patients whose first language was not English.

We spoke with five members of staff about the running of the practice and the support they received from management.

During the inspection we found there were risks of unsafe care and treatment.

We saw there were risks of harm to health and well-being through inappropriate sedation treatment and the unsafe management of medicines.

We observed the decontamination processes and storage of instruments and saw there was a risk of acquiring a healthcare associated infection because the practice did not have effective systems in place to prevent and control infections.

We looked at records and asked staff about how the quality of the service was monitored. We found there were few systems in place to monitor the quality and safety of the practice for the well-being of patients.