We carried out an announced comprehensive inspection on 16 January 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 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 Dental Implant Clinic is an implant training clinic based in Bath. The practice also provides other specialist dental treatment including restorative dental treatment, periodontics (specialised gum treatments) and adult orthodontics (the treatment of jaw and tooth irregularities). Patients who use the service are sometimes referred by their own dentists, and others self-refer. Treatment under conscious sedation is provided for patients who are very nervous about undergoing the surgical element of dental implant treatment. Given the nature of the treatments offered, very few, if any, patients under the age of 18 are treated at the clinic.

The practice is based in an adapted domestic dwelling situated near Bath. The practice had five dental treatment rooms, two of which are based on the ground floor. There was a separate decontamination room used for cleaning, sterilising and packing dental instruments. The practice opening hours are 8.45am - 5. 30pm Monday to Friday, the practice is closed at weekends. There were arrangements in place to ensure patients receive urgent medical assistance when the practice was closed.

The practice owner/ principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

We reviewed seven CQC comment cards that had been left for patients to complete prior to our visit and spoke with four patients. Patients commented they found the practice exemplary and staff were welcoming, friendly kind and caring. Several patients commented that staff go out of their way to help.

Patients commented staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained to them so they could make an informed decision which gave them confidence in the care provided. Thank you cards seen in the practice and on the website and the comment cards reviewed corroborated these comments.

Our key findings were:

• We found the practice ethos was to provide high quality patient centred implant and other specialist treatment in a relaxed and friendly environment.

• Staff we spoke with were committed to providing a quality service to their patients.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• Infection control procedures were effective and the practice followed published guidance. The practice appeared clean and well maintained.
• Patients’ needs were assessed, and specialist care and treatment were delivered, in accordance with current legislation, standards and guidance.

• Conscious sedation was provided in accordance with guidelines published by the Royal College of Surgeons and Royal College of Anaesthetists.

• Patients received information about their care, proposed treatment, costs, benefits and risks and were involved in making decisions about it. They had access to a treatment co-ordinator who ensured patients fully understood the proposed treatment.
• We were shown a comprehensive system was in place to gain valid informed consent from patients prior to treatment.
• Patients could access treatment and urgent and emergency care when required.
• There was a policy and procedure in place for recording adverse incidents and accidents. Evidence seen demonstrated learning from incidents took place and was shared across the practice team.
• We saw the practice had clinical governance and risk management structures in place although these could be strengthened to improve their effectiveness. For example in closer monitoring of staff training and the renewal of risk assessments by competent persons e.g. fire.
• Staff had received training appropriate to their roles and were supported in their continuing professional development by the principal dentist

• CQC patient comment cards gave a positive picture of a caring, professional and high quality service.

• Patients were treated with kindness, dignity and respect, and their confidentiality was maintained.

• The appointment system met the needs of patients, and emergency appointments were available.

• Services were planned and delivered to meet the needs of patients and reasonable adjustments were made to enable patients to receive their care and treatment.

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

• Review the practice infection control procedures and provide an annual statement about the practices’ infection control systems and processes giving due regard to the Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review policies and practices relating to fire management and ensure fire risk assessments are completed in a timely manner and identified actions implemented.
• Review systems for staff recruitment to ensure all relevant information is current.

Review systems for monitoring staff training and ensuring mandatory training is up to date.

We spoke with four people, attending the dental practice for dental implants. The people we spoke with told us that they were very happy with the treatment provided. People told us that they were fully informed at all stages of their treatment. This included details of the costs of any treatment required. They said that it was easy to make appointments and that the staff were good at trying to fit them in. They told us that they liked the dentists saying: ‘he explains what is going to happen, and I think the service is good and all the staff are friendly’.