We carried out this announced inspection on 18 February 2019 under 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.

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

Treharne and Harris Dental Surgery is in Paignton and provides NHS and private treatment to adults and children.

The dental practice is situated on the first floor, accessed by stairs. There is a chair lift for patients with limited mobility. Car parking spaces are available near the practice.

The dental team includes three dentists, seven dental nurses, one trainee dental nurse, two dental hygienists and three receptionists. The practice has four treatment rooms.

The practice is owned by an individual who is one of the principal dentists there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 60 CQC comment cards filled in by patients. This gave us a positive view of the practice.

During the inspection we spoke with three dentists, four dental nurses, one trainee dental nurse and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 8.30am – 5.30pm.

Tuesday 8.30am – 7.30pm.

Wednesday 8.30am – 5.30pm.

Thursday 8.30am – 5.30pm.

Friday 8.30am – 2pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff 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 staff 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• 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 staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

There were areas 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.
• Review the practice's responsibilities to consider the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010. In particular, by developing a plan of action as a result of audit.
• Consider broadening the scope of audit systems. In particular, by the inclusion of antimicrobial prescribing and dental implant procedures.

Treharne and Harris Dental Surgery employed two dentists, a dental surgeon, three hygienists, nine dental nurses and two receptionists on the day of our visit. The opening times were displayed on the company website, at the front entrance and on leaflets.

The surgery was able to provide an out of hours service and home visits if people had a specific medical need which made it difficult for them to attend the surgery. One person who had had an emergency appointment told us “I was seen very quickly, it’s always easy to get an appointment.”

We spoke with five people during our visit who attended for treatment. All of them told us that they were pleased with the service. One person told us “It’s exceptionally pleasant here. I’ve had a lot of work done on my teeth and I’m very satisfied.”

We spoke with six staff during our visit. All of the staff we spoke with told us that they had received training in safeguarding vulnerable adults and child protection and that they understood how to recognise and report any concerns they had.

The practice had measures in place to deal with foreseeable emergencies. Staff had received first aid training and we found that all required emergency equipment was up to date and easily accessible.

The practice was modern and clean. Clinical areas were well organised, spacious and well lit.

The practice had checks in place to monitor the quality of care provided. We found a robust audit system was in place.