We carried out an announced comprehensive inspection on 18 November 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

The practice was first established in the 1940’s, and is the only practice in the town of Kirkby Stephen. The current practice has been owned by Dr Mirza since 2015. There are currently 900 patients registered with the practice. The provider is in the process of rebranding the practice to Bismillah Smile Studio.

Dental practice is located in a grade 2 listed building with all dental services on the ground floor. The practice provides predominantly private treatment to patients of all ages and NHS treatments for children. There are two treatment rooms, a decontamination room for sterilising dental instruments, a staff room/kitchen and a reception. Access for wheelchair users or pushchairs is possible by a ground floor entrance. Car parking spaces were available in front of the practice and around the market square.

The practice is open Monday and Wednesday 0900-1900, and Friday from 0900-12.30. Tuesday and Thursday there is no dental service available but the reception is open.

The dental team is comprised of the principal dentist, one dental nurse, a trainee dental nurse who also acts as the practice manager, one part-time dental hygienist and one receptionist.

The practice provides general dentistry under private treatment plans.

The principal dentist 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.

We reviewed 42 CQC comment cards on the day of our visit; patients were extremely positive about the staff and standard of care provided by the practice. Patients commented they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.

Our key findings were:

• The practice was well organised, visibly clean and free from clutter.
• An Infection prevention and control policy was in place. We saw the sterilisation procedures followed recommended guidance although there was no designated time for the dental nurse to undertake decontamination procedures.
• The practice had systems for recording incidents and accidents.
• Practice meetings were used for shared learning.
• The practice had a safeguarding policy and staff were aware on how to escalate safeguarding issues for children and adults should the need arise.
• Staff received annual medical emergency training. Equipment for dealing with medical emergencies reflected guidance from the resuscitation council.
• Dental professionals provided treatment in accordance with current professional guidelines.
• Patient feedback was regularly sought and reflected upon.
• Patients could access urgent care when required.
• Dental professionals were maintaining their continued professional development (CPD) in accordance with their professional registration.
• Complaints were dealt with in an efficient and positive manner.
• The practice was actively involved in promoting oral health.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society and review the process for the recording of the reason for not using rubber dams when undertaking extensive dental treatments in the patients notes.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.
• Review the practice’s audit protocols of various aspects of the service, such as radiography and dental care records at regular intervals to help improve the quality of service. Practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice’s procedure when undertaking domiciliary visits with regards to taking the practice’s emergency equipment with them.
• Review the use of traditional, unprotected medical sharps and substitute with a ‘safer sharp’ where it reasonably practicable to do so.
• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded.