We carried out this announced inspection on 8 August 2017 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

Warrendale Dental Care is located in the Herefordshire market town of Ross-on-Wye and provides predominantly private treatment with a small NHS contract to patients of all ages.

There is level access for people who use wheelchairs and pushchairs due to investment in a large ramp to the front of the building. The ground floor of the practice consists of a reception area, a waiting room, a patient toilet, three dental treatment rooms, an x-ray room, a practice management office and a decontamination room for the cleaning, sterilising and packing of dental instruments. On the first floor there is a staff room, a kitchen and staff toilet facilities. Car parking spaces, including spaces for patients with disabled badges, are available in local streets, or pay and display car parks near the practice.

The dental team includes two dentists who are both partners of the practice, four dental nurses, a dental hygienist, two receptionists and a practice manager. The practice has three treatment rooms.

The practice is owned by two partners who are 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 47 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, two dental nurses, the dental hygienist, one receptionist 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 9am - 5.30pm

Tuesday 9am - 7.30pm

Wednesday 9am - 5.30pm

Thursday 9am - 5.30pm

Friday 9am - 4.30pm

Our key findings were:

• The practice was visibly clean and well maintained. An employed cleaner was responsible for the day to day cleaning.
• The practice had infection control procedures which reflected published guidance.
• Staff had been trained to handle medical emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• 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 staff recruitment procedures however a recruitment policy was required to underpin the procedures and ensure retention of staff ID and CVs on personnel files.
• 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. Patients could access treatment and urgent and emergency care when required.
• Strong and effective leadership was provided by the principal dentists and an empowered practice manager. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided. Information from 47 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.
• The practice had a comprehensive system and policy to deal with complaints positively and efficiently.

We identified an area of notable practice:

• The practice were very committed to supporting a diverse range of local community groups and providing preventive oral hygiene advice. A practice nurse visited local nursery groups to support and advise parents on oral health matters for babies and children. She also visited local schools to educate children in tooth brushing techniques and deliver healthy eating advice. In addition to this, the practice nurse also visited local care homes and held talks for various local groups in the community.

We spoke with four adults and a young person during the inspection and with three people by telephone afterwards. Two people agreed to us being in the surgery during their appointments. This gave us the opportunity to see how the dentist and dental hygienist communicated with people. People told us they had confidence in the dentist and the dental team.

We observed that all members of the team put people at their ease during their treatment. People told us that what we saw was how it always was. The young person told us they felt fine about visiting the dentist because he was nice.

There was medication and oxygen available for certain medical emergencies and staff were trained to know what to do if a person became unwell at the practice.

The practice was clean and people we spoke with told us they thought standards of cleanliness were very good. There were suitable arrangements for the cleaning, sterilising and storing of instruments. Staff described these procedures to us confidently.

The dental team were qualified and maintained their continuous professional development (CPD) as required by the General Dental Council (GDC). The practice manager kept a file with each person’s training records to help monitor this.

The practice had both internal and external arrangements for monitoring the quality of the service. There were arrangements for assessing and reducing any risks to people using the service or staff.