We carried out an announced comprehensive inspection on 5 July 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

Thorley Dental Practice is a general dental practice situated in the Thorley district of Bishop’s Stortford, Hertfordshire. The premises are within a retail development, and have ample parking available in front of the practice.

The practice provides treatment on a private basis to adults and children. The premises consist of two treatment rooms, and waiting area/ reception area and a separate X-ray room.

The practice did not have a dedicated decontamination facility; cleaning and sterilisation of dental instruments was taking place in the treatment rooms. We saw builders’ plans for alteration to the premises that allowed for construction of a decontamination room. We were told that work would commence in the coming months.

The 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.

The practice was first registered with the Care Quality Commission (CQC) in February 2012.

We received positive feedback from eight patients about the services provided. This was through CQC comment cards left at the practice prior to the inspection.

Our key findings were

• The practice was visibly clean and clutter free.

• Patients reported positive experiences at the practice and commented that they were treated with care and professionalism.

• The practice could normally arrange a routine appointment within a week and emergency appointments mostly on the same day.

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.

• The practice did not have all the emergency equipment recommended by the Resuscitation Council UK for use in a medical emergency, although this was all purchased shortly following our inspection.

• The clinicians used nationally recognised guidelines in the care and treatment of patients.

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.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• 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, and review the use of rectangular collimation on the intra-oral X-ray machine to reduce the effective dose of radiation to the patient.

• 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.

During our inspection on 22 April 2013 we found that people’s privacy and dignity was not always respected and that people were not always protected from the risk of infection because appropriate guidance had not been followed.

When we visited the service on 03 September 2013 we found that the provider had made alterations to the reception area to promote people’s privacy and confidentiality. We found that the provider had removed a cupboard that had bare and untreated surfaces, provided illuminated magnifying glasses for the treatment rooms and provided refresher training for the staff team in the control of infection.

People who used the service told us that they found the service to be very clean and they felt their dignity was generally respected.

We spoke with three people who used the service, two of whom had used the service for a number of years. They all told us they were satisfied with the care and treatment they received.

Records showed that care and treatment was planned in a way that was intended to ensure people's safety and welfare. They showed that people were given appropriate information on which to make decisions about their treatment.

We found that the environment did not always support people's dignity, confidentiality or privacy, both in the reception area and in one of the treatment rooms.

Infection control practices were not always adhered to. For example, we saw some surfaces in the surgery that were permeable and not suitable to be sterilised inbetween patients.

People using the service told us that staff were friendly and courteous.