We carried out this announced inspection on 22 May 2018 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

Valley Dental Practice is in Buckhurst Hill, Essex and provides NHS (63%) and private (37%) treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available near the practice.

The dental team includes nine dentists, five dental nurses, one dental hygienist, two receptionists and one practice manager. The practice has four treatment rooms.

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 Valley Dental Practice is the senior partner.

On the day of inspection we collected 32 CQC comment cards filled in by patients.

During the inspection we spoke with five dentists, two dental nurses, two 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 from 8:30am to 5:30pm.

Tuesday from 8:30am to 5:30pm.

Wednesday from 8:30am to 5:30pm.

Thursday from 8:30am to 8:00pm.

Friday from 8:30am to 5:30pm.

Saturdays from 8:30am to 1pm.

Our key findings were:

• Strong and effective leadership was provided by the principal dentists and an empowered practice manager.
• The practice was visibly clean and well maintained.
• The practice had well organised systems to assess and manage infection prevention and control 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 an established process for reporting and recording significant events and accidents to ensure they investigated these and took remedial action.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• 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 practice asked staff and patients for feedback about the services they provided. Patients were very happy with the quality of their treatment and the staff who delivered it.
• The practice dealt with complaints positively and efficiently.
• The appointment system met patients’ needs. Patients could access treatment and urgent and emergency care when required.
• Staff had received training appropriate to their roles and were supported in their continued professional development by the principal dentist and practice manager.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

We identified an area of notable practice.

• The practice took their responsibility for safeguarding vulnerable adults and children very seriously. They believed a successful safeguarding management programme needed to have a monitoring element so that as healthcare professionals the practice could intervene to support carers, parents or guardians. The team were aware of forms of neglect and abuse and how to raise concerns but believed there was a need for a monitoring system of these patients ‘in between’. The practice had identified that patients could often get lost in the system with a potential loss of continuity of care. In particular if these patients were seen by a number of healthcare professionals. In early 2017 the practice developed a monitoring system to identify and monitor adults and children that were vulnerable. The dentists would notify the reception team of patients they were concerned about. These included amongst others patients missing routine exams, high numbers of caries, poor oral hygiene, poor diet or missing referral appointments. This triggered a monitoring system which enabled the practice to monitor the patients’ attendance. In addition the practice team described working with other services such as social services and the school nurses to ensure the safety of their patients and promote effective oral care and treatment. The practice team told us that by being proactive, identifying and monitoring these patients they had seen good results. The practice described how this had enabled them to build a good rapport with patients, parents carers and/or guardians and ensured they were aware of the support available from the practice.

We found that treatment was planned in a way that was intended to ensure people's safety and welfare. People were cared for in a clean, hygienic environment. There were effective systems in place to ensure that people were protected from the risk of infection.

We spoke with four people who used the service during our inspection. They all told us they were satisfied with the treatment they received at Valley Dental Practice. They confirmed that that they were given good information about planned treatments so they could make the right decision for them on how to proceed. One person told us, “They have been very patient with me. I cannot fault the treatment. Overall I would give it 10 out 10.”

We saw that arrangements were in place to support people’s diverse needs. This included arrangements for information to be made available in other languages or in Braille and suitable facilities that supported people who used wheelchairs to access the service.

People were cared for by staff who were supported to deliver treatment safely and to an appropriate standard. The provider had effective systems in place to gather and listen to the views of the people who used the service and to monitor the quality and safety of the service people received.