We carried out this announced inspection on 6 December 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. NHS England provided us with information about the contract they hold with the practice.

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

West Hill Dental Care is in Ottery St Mary and provides mostly NHS treatment to patients of all ages. The practice offers a small amount of private dentistry.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available at the practice.

The dental team includes one dentist, one dental nurse, one trainee dental nurse and one receptionist. The practice has one treatment room.

The practice is owned by an individual who is the principal dentist 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 26 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the dentist, trainee dental nurse and receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday for seven hours each day.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies.
• 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 thorough staff recruitment procedures.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided.
• The practice had not received any complaints.

There were areas where the provider could make improvements. They should:

• Review the practice protocols and adopt an individual risk based approach to child patient recalls taking into account National Institute for Health and Care Excellence (NICE) guidelines.

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review the use of risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities. In particular with regard to fire safety and alternative safety systems if a rubber dam is not used.

• Review the practice's protocol and staff awareness of their responsibilities under the Duty of Candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This was the provider’s first inspection for this practice since dental services were required to register with the Care Quality Commission.

On the first day of our inspection some of the equipment malfunctioned which meant a small number of patient appointments had to be cancelled. The dentist and the receptionist managed this situation in a professional and prompt way. Replacement equipment was sourced promptly and patients were offered appointments later in the day or at a time which suited them. We chose to return to the service the following day to complete our inspection.

The practice provides dental services for NHS patients as well as offering private dental services. During our inspection we spoke with nine patients about their experiences of using the service on the two days we visited the service; these people made positive comments about the practice and the dental care they received. One person told us, “I can’t fault the practice; it couldn’t be better. The staff are very nice”. Another person told us, “I’m kept well informed and everything I’ve asked about my treatment has been answered”.

We saw people were greeted politely by the receptionist and dental team and they received their examinations in private. We asked people how they were involved in their treatment planning and whether they were informed about what the treatment might involve. People told us how the dentists involved them at all times, and gave them sufficient information to make decisions and choices about their treatment. Information about the costs of treatment, the services provided and managing oral health care were available in the surgery reception area.

We looked at the surgery and other areas of the practice and were satisfied people received safe and effective treatment in a clean environment. Processes were in place to ensure hygiene standards were maintained. We met and spoke with the majority of the staff working in the practice during our inspection and checked staff records to ensure appropriate recruitment took place. We found that patient records were detailed and were up to date and reflected the treatment received that day.

We looked at information relating to the management of the practice and saw these were up to date. The receptionists checked people’s information was correct when they arrived for appointments and dentists’ updated people’s records on their computer and paper record systems after each consultation ensuring patient information was current.