We carried out this announced inspection on 12 October 2017under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. NHS England provided us with information about the contracts they hold with the practice.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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

Torrington Dental Practice is in Great Torrington in rural Devon and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including spaces for patients with disabled badges, are available near the practice. The practice has six treatment rooms, two of which are located on the ground floor.

The dental team includes eight dentists, one orthodontist, one hygienist, two oral health educators, ten dental nurses, two trainee dental nurses, two sterilisation room assistant, four receptionist/administrators, one cleaner and a practice manager.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Torrington Dental Practice was one of the partners.

On the day of inspection we collected 44 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with six dentists, one hygienist, eight dental nurses, one sterilisation room assistant, three receptionists and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 8.30am – 7pm. Tuesday 8.30am – 5.30pm. Wednesday 8.30am – 5.30pm. Thursday 8.30am – 5.30pm. Friday 8.30am – 5pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

We identified an area of notable practice.

• The practice had implemented a number of oral health education initiatives. This included a care of the elderly programme working collaboratively with the practice domiciliary team. This initiative showed a deep commitment to the promotion of oral health in the community.

There was one area where the provider could make improvements. They should:

• Review protocols for domiciliary visits taking into consideration the British Society for Disability and Oral Health – Guidelines for the Delivery of a Domiciliary Oral Healthcare Service. In particular with regard to emergency equipment, emergency procedures and waste transportation.

We inspected Torrington dental practice on 1 October 2013. We looked at the records of four people in detail and spoke with them during their appointment. We met another three patients who were attending appointments accompanied by relatives and spoke to a further three people over the telephone who use the domiciliary dental service.

We asked NHS Devon for their comments because they have a monitoring role in the commissioning of NHS dental care at this practice. NHS Devon reported there were no concerns with this practice.

Patients made positive comments about their experience of treatment at the dental practice. For example, a patient who had treatment under sedation told us they felt “comfortable and very relaxed”. Another person said “This is a lovely surgery and they offered me the option of using a ground floor room because I couldn’t manage the stairs”. We followed four people’s appointments from start to finish. We saw dentists always asked people about their health and explained treatment options with each person before starting.

The practice had systems in place which meant patients were safe and well cared for. For example, the environment was clean and equipment safe to use because decontamination and cleaning procedures were robust. The team were motivated and caring towards patients. For example, a review of the sedation service had taken place in which patients views had been obtained and learning from their comments was used to make improvements.