We carried out an announced comprehensive inspection on 23 March 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 Old Surgery Dental Practice is located in a residential suburb close to the centre of Crewe and comprises a reception and waiting room, a patient care suite, a patient lounge, six treatment rooms, three of which are on the ground floor, offices, storage and staff rooms. Parking is available on nearby streets. The practice is accessible to patients with disabilities, impaired mobility and to wheelchair users.

The practice provides general dental treatment to patients on an NHS or private basis.The practice opening times are Monday, Tuesday, Wednesday 9.00am to 5.15pm, Thursday 9.00am to 7.15pm and Friday 9.00am to 5.00pm. The practice is staffed by a management team of six staff, 11 dentists, two of whom are the practice partners, two hygienists, a clinical dental technician, two treatment co-ordinators / dental nurses, four receptionists, three of whom are also dental nurses, and four dental nurses, one of whom is a trainee.

One of the principal dentists 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.

We received feedback from 26 people on CQC comment cards during the inspection about the services provided. Every comment was positive about the staff and the service. Patients commented that they found the staff welcoming, friendly, kind and and caring. They said that they were always given good explanations about dental treatment and that dentists listened to them. Patients commented that the practice was exceptional, provided a superb service and had been outstanding over the last few years.

Our key findings were:

• The practice recorded and analysed significant events and incidents and acted on safety alerts.
• Staff had received safeguarding training and knew the process to follow to raise any concerns.
• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies, and emergency medicines and equipment were available.
• Premises and equipment were clean, secure and well maintained.
• Infection control procedures were in place and the practice followed current guidance.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current legislation, standards and guidance.
• Patients received explanations about their care, proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• We observed that 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.
• The practice gathered the views of patients and took into account patient feedback.
• Staff were supervised, felt involved and worked as a team.
• Governance arrangements were in place for the smooth running of the practice and for the delivery of high quality person centred care.

We identified the practice did the following which had a positive impact on patient experience and health outcomes. We believe this to be notable practice.

• There was a practice team approach to improving the oral health of patients and the local population. As a practice they planned annually who and how they target. The practice actively identified specific population groups who were at an increased risk of poor oral health and planned and implemented a number of initiatives specifically targeting these groups. For example, this year they were building on the work they had previously carried out in training nursing home staff to carry out oral health care, and were focusing on people living with dementia.
• Staff proactively worked with health professionals, for example, to improve the outcome for patients with long term conditions such as diabetes by providing oral health education and encouraging regular dental attendance. Staff also aimed to improve referral pathways to GPs to screen for diabetes in patients whose oral health was of concern.
• The practice organised a variety of educational opportunities for their own staff and those from local practices with a strong emphasis on sharing of clinical expertise and knowledge, best practice and peer review to improve patient outcomes.
• When planning care, the provider considered the nutrition and hydration needs of patients. In particular, appointments were planned at specific times of the day for patients who were fasting, and the nutrition and hydration needs of patients undergoing treatment in lengthy appointments were considered. The practice also produced detailed guidance on nutrition and hydration for patients who had attended for a variety of treatments, for example, dentures, sedation and periodontal, (gum), treatment. The guidance included information on suitable amounts, types and temperatures of food and drink, and precautions to be aware of.

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

• Review arrangements for the secure storage of waste in accordance with relevant regulations having due regard to guidance in the Department of Health, Health Technical Memorandum 07-01 Safe management of healthcare waste.
• Review the practice’s sharps procedures having due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.