We carried out an announced comprehensive inspection on 9 February 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 Square Advanced Dental Care is located in the centre of Hale Barns and comprises a reception and waiting room, two treatment rooms, a decontamination room, an office and storage and staff rooms. All rooms are situated on the first floor, accessible by stairs or a lift. Parking is available to the rear of the practice.

The practice provides general dental treatment and a range of more complex treatments, for example, implants and orthodontic treatment, to private patients. It also operates as a referral practice, accepting patients referred from other dental practices for specialist treatment on a private basis.

The practice is open

Monday 9.00am to 5.30pm

Tuesday 8.30am to 7.30pm

Wednesday 9.30am to 8.00pm

Thursday 9.00am to 5.30pm

Friday 8.45am to 5.30pm

Saturday by appointment

The practice is closed for lunch between 1.00pm and 2.00pm.

The practice is staffed by seven dentists, a practice manager, four dental nurses, one of whom is the senior nurse, and another, the treatment co-ordinator, a dental therapist and a receptionist. There are two visiting dentists who provide ad hoc sessions as required.

One of the directors 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.

Nine people provided feedback about the services provided. Feedback reflected very positive comments about the staff and the service. Patients commented that the practice was clean and hygienic, and they found the staff friendly, considerate and caring. They had trust in the staff and confidence in the dental treatments, and said explanations were clear, detailed and understandable.

Several of the dentists deliver the MSc course in Restorative Dentistry under their separate training company in conjunction with The University of Chester, and are involved in teaching on this course.

Our key findings were:

• The practice recorded and analysed significant events, incidents and complaints and cascaded learning to staff.
• Staff had received safeguarding training and knew the processes to follow to raise any concerns.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies and emergency medicines and equipment were readily available.
• Premises and equipment were clean, secure and properly maintained.
• Infection control procedures were in place and the practice followed published guidance.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• Clinical staff were up to date with their continuing professional development and met the requirements of their professional registration.
• Patient’s care and treatment was planned and delivered in line with evidence-based guidelines, and current practice and legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and delays were kept to a minimum.
• The practice staff felt involved and worked as a team.
• The practice sought feedback from staff and patients about the services they provided.
• Governance arrangements were in place for the smooth running of the practice and the practice had a structured plan in place to audit quality and safety.

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

• Review the frequency of checks on medical emergency equipment in line with Resuscitation Council UK guidelines, and review procedures for stock control of medicines.
• Review the storage of cleaning equipment.
• Devise a method of checking and recording that visiting dental professionals have completed continuing professional development training in core subjects.

During our inspection we spoke with two people receiving treatment and they told us:

“When I had a lot of work done, everyone (staff) were there to support me, I was extremely nervous. I trust the staff and you get emotional support as well as all the information you need before treatment.”

“If I have ever had any worries or concerns about my treatment, I was able to come back and talk things through and if necessary they have changed the process for me.”

The practice had a comprehensive consent policy. The manager told us “We are so aware of consent, much of our work is restorative and irreversible, and so gaining consent throughout the whole process is essential.”

We observed reception staff and the dental practice manager greeting patients, creating a welcoming atmosphere and checking with patients before and after treatment.

The safeguarding policies gave staff a clear flow chart of action to take if they suspected abuse and included contact details of who to refer to locally.

We observed that all areas of the premises were maintained to a high standard, with all areas clean and tidy. We spoke with the manager and lead nurse for infection control; they were clear about their roles and responsibilities.

The provider had a range of systems in place to monitor the quality of the treatment and services provided to patients.