We carried out an announced comprehensive inspection on 17 September 2015 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.

Twickel Dental Limited provide NHS and private dental treatment and the majority of patients at the practice are NHS. The practice is situated in a rural area of Shropshire, Much Wenlock. The majority of the population (44.6%) who receive a service from Twickel Dental Limited are aged 55 years or older, with 35.4% of the practice patients being of working age and 20% were children. Twickel Dental Limited has a principal dentist who works between four and five days per week and a dental associate who works five days per week. The practice team includes a dental hygienist who works on a Friday each week and four dental nurses. One of the dental nurses primarily works in a receptionist/practice manager role.

Twickel Dental Limited practice premises had been subject to recent refurbishment. The treatment room surgeries are fully equipped and the reception area is now separated from the waiting room to enable further patient privacy. The reception area and waiting room are on the ground floor. The main entrance to reception has a couple of steps that patients with restricted mobility are aware of. The practice has a separate side door entrance which patients with restricted mobility can use to access the service. The practice has two dental treatment rooms. These rooms contain spacious areas for the decontamination and cleaning, sterilising and packing of dental instruments.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to use to tell us about their experience of the practice. We collected 14 completed cards and spoke with two patients. These provided a positive view of the service the practice provides. Patients told us the practice was welcoming and that the dentist was understanding, thorough and helpful. Several patients specifically commented that the dentist put them at ease. We spoke with four staff members all were particularly good at understanding the needs of people living with dementia illnesses and those with learning disabilities. They understood their responsibilities under the Mental Capacity Act (2005).

The practice is part of the British Dental Association Good Practice scheme. The business is operated by a private limited company which has one director who is also the registered manager with CQC. 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.

Our key findings were:

• The practice had systems for dealing with significant events and accidents and staff understood their responsibilities for providing a safe service.
• The practice was visibly clean and had processes to help staff manage infection prevention and control effectively.
• The practice had systems, medicines and equipment for the management of medical emergencies and staff were trained to know how to deal with these.
• The practice had safeguarding processes and staff understood their responsibilities for safeguarding adults and children.
• Clinical records included the essential information expected about patients’ care and treatment including treatment plans and consent to care and treatment.
• The practice was committed to staff education and development. Staff received training appropriate to their roles and were encouraged and supported in their continued professional development (CPD).
• The practice had received one complaint in eight years and had a clear system for handling and responding to complaints.
• Patients who completed Care Quality Commission comment cards were pleased with the care and treatment they or their family member received and were complimentary about the whole practice team.
• The practice had well organised governance and leadership arrangements and an open door policy which made staff feel valued and listened to with few exceptions. The exception were for example, a lack of management oversight on staff training to be assured that all staff were up to date with their training needs and a lone working policy.
• The practice had open and supportive leadership and staff were happy in their roles, professional and enthusiastic.

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

• Ensure necessary employment checks are in place for all staff and records held of the required specified information in respect of persons employed by the practice in line with Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Consider further detail on the health promotion advice given and verbal consents within the patient records.
• Further improve the security of prescription pads in line with NHS Protect guidelines.
• Formalise the practice induction training and ensure staff receive appropriate training in Health and Safety and ensure regular fire awareness training for staff employed at the practice.
• Ensure documentation and risk assessments are in place when informed by suppliers that a particular medicine for emergencies in no longer available.
• Consider a lone working policy.

As part of our review we spoke with six people who used Twickel Dental Practice to gain their experiences of the service they received. People we spoke with included a family with young children, people who were nervous, had received extensive treatment, were new to the practice, or had attended the practice since it first opened in 2008.

Everybody we spoke with shared positive experiences about the care, treatment and support they received at the practice. They said they were always made welcome by the staff, were seen on time and were fully involved in their treatment. One person said, “They are unbelievable, just amazing. They discuss and show me everything. They are way above anything I’ve experienced in a dental practice before; it’s so refreshing to go there”. Another person said, “It’s a very nice dental surgery and an asset to the town”. Everybody told us they were “very” satisfied with the service and had recommended the dental practice to their family and friends.

People told us they had completed an oral health questionnaire when they first registered with the practice and were asked at each appointment if there had been any changes to their health. Two people said they had a health condition and confirmed their dentist was aware, supportive and sensitive to their individual needs. They told us their dentist had adjusted their treatment to accommodate their needs.

People told us they had not received treatment they did not require. One person said their dentist had advised them against having cosmetic treatment (tooth whitening) as it would not have been in their best interests. One person, who was once “terrified” by their poor experience of a dentist, told us they no longer had any anxieties about going to the dentist. They said “I don’t know anyone who fears going there, everything they do is done to a high standard and they really put you at ease”.

Discussions with four staff clearly evidenced they enjoyed their work and were passionate about ensuring people were seen and treated as individuals. One staff member said, “I love it, it’s the best choice I have ever made, we’re really supported and work well as a team”

People expressed no concerns in relation to the infection prevention and control measures in place and confirmed that clinical staff always wore personal protective clothing such as a uniform, gloves and eye protection.

We received information from Shropshire PCT who visited the practice on 28 July 2011 to undertake an infection prevention and control audit. They told us the practice received an overall score of 99%. They said the practice had comprehensive infection control policies and procedures in place.