We carried out an announced comprehensive inspection on 15 February 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 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 not providing well-led care in accordance with the relevant regulations.

Background

Woodbridge Hill Dental Practice provides private and NHS treatment to both adults and children in Guildford. The practice is located on first floor premises accessed by an internal stair case. There are five treatment rooms one of which has been decommissioned, a waiting room with separate reception area and a separate decontamination room. The practice is open between 8.30am and 6pm Monday to Friday.

The practice consists of the principal dentist, two associate dentists, two dental nurses, a dental hygienist, a trainee dental nurse and two receptionists. At the time of our inspection the practice did not have a practice manager. The principal dentist had taken over the practice seven months prior.

The principal dentist was 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.

The inspection took place over one day and was carried out by a CQC inspector and a dental specialist advisor.

We received feedback from four patients about the service. The feedback was positive and patients commented on the friendly and helpful reception staff. Additionally, patients commented that they felt listened to and that the service they received was good.

Our key findings were:

• Patients were treated with dignity and respect and confidentiality was maintained.
• There was a process in place for the reporting of untoward incidents that occurred in the practice.
• The dental care records we saw appeared to show that dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The practice had most emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practices. However not all staff had received adequate training in medical emergencies.
• The practice had some processes in place for safeguarding adults and children living in vulnerable circumstances although not all staff had received safeguarding training nor were they aware of the procedures to follow.
• Improvements could be made to the practice’s decontamination procedures to ensure staff were following national guidance for infection prevention and control in dental practices
• There was no structured plan to gain feedback from staff for the purpose of making continual improvements.

• New staff did not receive an induction upon commencing working at the practice.
• Staff had not received an appraisal and there was no structured monitoring of training completed by staff and no system to identify training needs.
• The practice had not completed a fire evacuation drill since June 2016, during which time the practice had recruited several new staff members.

We identified regulations that were not being met and the provider must:

• Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and appraisal of all staff.

• Ensure that the staffing levels are reviewed to ensure that there are sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of patients.
• Ensure the practice establishes an effective system to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure systems are in place to assess, monitor and improve the quality of the service such as undertaking regular audits of various aspects of the service and ensuring that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).
• Review current systems to ensure internal communication and shared learning are promoted amongst the practice staff.
• Review current systems to ensure that feedback from patients and staff is sought and acted on for the purposes of continually evaluating and improving services.