We carried out an announced comprehensive inspection on 6 March 2017 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Wells Hill Dental Practice is a dental practice providing predominantly private treatment for adults and NHS treatment for children. The practice is located close to local shops and has some on site car parking. The location is accessible to patients in wheelchairs. Patients who use wheelchairs can be treated in a ground floor treatment room. All other treatment rooms for patients are on the first floor.

The practice employs one dentist (the principal dentist), two hygienists, four dental nurses (one of whom is also the practice manager) and two reception staff. Fees are displayed on the practice website and in the reception / waiting area.

The practice opens Monday, Tuesday and Thursday 9am to 5pm, Wednesday 9am to 5.30pm, and Friday 9am to a variable closing time. Saturday and Sunday the practice is closed. There are arrangements in place to ensure patients receive urgent dental assistance when the practice is closed. This is provided by an out-of-hours service.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

Before the inspection, we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 98 patients. In addition we spoke with four patients on the day of our inspection. Feedback from patients was positive about the quality of care, the caring nature of all staff and the overall high quality of customer care. They commented that staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained them so they could make an informed decision which gave them confidence in the care provided.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Effective leadership was provided by the principal dentist and practice manager / dental nurse.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines. However we observed that some of the emergency equipment had passed its expiry date and regular checks on the Automated External Defibrillator (AED) were not recorded.
• Premises appeared well maintained and visibly clean, with the exception of a wall in the ground floor toilet that required attention to ensure it could be properly cleaned.
• Good cleaning and infection control systems were in place and the practice followed published guidance.
• The treatment rooms were well organised and equipped, with good light and ventilation.
• There were systems in place to check all equipment had been serviced regularly, including the autoclaves and the X-ray equipment.
• The practice had a safeguarding lead professional and effective processes in place for safeguarding adults and children.
• There was a policy and procedure in place for recording adverse incidents and accidents.
• The dentist and dental hygienists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• .The practice had a system to monitor and continually improve the quality of the service. However, the audits for radiograph (quality and justification) and record keeping were due to be carried out.
• Patients could access treatment and urgent and emergency care when required.
• Staff had received training appropriate to their roles and were supported in their continuing professional development by the principal dentist.
• Staff we spoke with felt well supported by the practice owner and were committed to providing a quality service to their patients.
• The practice reviewed and dealt with complaints according to their practice policy.
• The practice carried out regular patient surveys and made changes as a result of feedback.
• We found prescription pads were not logged and the number of a prescription issued was not recorded in the patient clinical record.
• Medicines were stored in a refrigerator with food and drink and fridge temperatures were not monitored or suitably recorded.

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

• Review the logging of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review stocks of equipment and the system for identifying and disposing of out-of-date stock.
• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
• Review the fabric of the wall in the ground floor toilet to enable appropriate cleaning

Review access to interpreter services for consultations with patients whose first language is not English.

Patients were complimentary about the staff at the practice saying they put people at ease and were very friendly. Where patients had a course of treatment they told us each visit would be described in the treatment letter along with costs so that they knew what to expect at each visit. One of the patients we spoke with was visiting the dentist as an emergency. They were pleased that the practice had fitted them in on the same day.

Staff we spoke to were aware of the action to take should they have concerns about a child's safety. Staff we spoke with were not fully aware of the Mental Capacity Act 2005 and what steps should be taken to support people who are unable to make their own decisions about treatment.

People receive care and treatment in a clean environment. We found that checks on one piece of equipment had not been completed.