We carried out an announced comprehensive inspection on 17 October 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.

Ware Dental Care is a busy predominantly NHS practice on Ware High Street in Hertfordshire. The practice offers a range of general dental treatment and also holds a contract for the provision of minor oral surgery. The premises are located on the ground and first floor and consist of seven dental treatment rooms and a large reception and waiting area and a separate decontamination area.

The staff at the practice consist of two principal dentists, six associate dentists, a practice manager, 13 dental nurses (some of whom also cover reception duties), two dental hygienists and a receptionist. The practice also employs the services of a specialist in periodontics and three specialists in oral surgery.

One of the principal dentists is the registered manager. 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:

• There was an induction programme for staff to follow which ensured they were skilled and competent in delivering safe and effective care and support to patients.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• There were effective systems in place to reduce the risk and spread of infection. We found the treatment rooms and equipment were visibly clean.

• There were systems in place to check equipment had been serviced regularly, including the dental air compressor, autoclaves, fire extinguishers and the X-ray equipment.

• We found the dentists regularly assessed each patient’s gum health and the dentist took X-rays at appropriate intervals.

• The practice kept up to date with current guidelines when considering the care and treatment needs of patients.

• The practice placed an emphasis on the promotion of oral and general health and the prevention of dental disease. Appropriate information and advice was available according to patients’ individual needs.

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available.

• Patients received comprehensive assessments of their oral health needs. They were given clear explanations about their proposed treatment, and its costs, benefits and risks and were involved in making decisions about it.

• Patients were treated with dignity and respect and confidentiality was maintained.

• The appointment system met the needs of patients and waiting times were kept to a minimum.

• There was an effective complaints system and the practice was open and transparent with patients if a mistake had been made.

• Staff demonstrated knowledge of the practice whistleblowing policy and were confident they would raise a concern about another staff member’s performance if it was necessary.

• At our visit we observed staff were kind, caring, very welcoming and worked well as a team.

• There was an effective system in place to act on feedback received from patients and staff.
• We reviewed 25 Care Quality Commission (CQC) comment cards that had been completed by patients prior to our inspection. Common themes were patients felt they received excellent care in a calm and hygienic environment from staff who were caring, polite and informative.

When we inspected Ware Dental Care we found that people were given information about their treatment and they were asked for their consent. One person using the service on the day of our inspection said, “I got lots of information about the replacement of one of my fillings... I was asked for my consent and I have signed a consent form.” Another person said, “I received information about costs before I signed the form.”

People’s needs were assessed and treatment was planned and delivered in line with those needs. One person said, “I feel as if I am involved in my treatment plan. I have had [a particular dental problem] so the dentist has been treating me specifically for that.”

There were arrangements in place to deal with medical emergencies. Staff had received life support training and the provider maintained up to date medicines and equipment.

The provider processed used instruments in accordance with Department of Health Guidance within their recently refurbished sterilisation facilities.

Staff were supported by regular training, appraisals and a meeting structure. Clinically qualified staff embarked on continuing professional development to maintain their registration.

The provider actively monitored the quality of service by way of regular audits and by capturing the feedback of people using the service. For example, we saw that the provider had refurbished a large part of the building as a result of an infection control audit and patient feedback.