We carried out an announced comprehensive inspection on 21 April 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.

Woodhall Dental Practice is a general dental practice in Welwyn Garden City, Hertfordshire offering NHS and private dental treatment to adults and children.

The premises are located all on the ground floor in commercial premises within a parade of shops. The practice consists of three treatment rooms, a reception area and a waiting area. There is also a designated decontamination area in between and access through two of the treatment rooms. There is ample free parking.

The staff at the practice consist of a practice manager, a principal dentist, two associate dentists, a dental nurse and two trainee dental nurses. The practice manager 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 and training 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, oxygen cylinder and the X-ray equipment.

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

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

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

• Patients received clear explanations about their proposed treatment, 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.

• 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 caring and professional.

• We received feedback from 33 patients who reported they received a high standard of care from friendly staff in a clean and relaxing environment.

• There was an effective system in place to act on feedback received from patients and staff.

• There were systems in place to assess, monitor and improve the quality of service provided.

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

• Review the process for maintaining dental care records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review audit protocols to ensure learning points are shared with all relevant staff and that the resulting improvements can be demonstrated as part of the audit process. For example, with regard to their radiography and record keeping audits.

• Review the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray giving due regard to the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) 2000.

• Review the protocol for maintaining accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal references taken and ensuring recruitment checks, including references, are suitably obtained and recorded.

• Review the availability of hand towel dispensers next to each hand wash sink and ensure the ‘clean’ and ‘dirty’ zones are clearly demarcated in each treatment room.

We previously inspected Woodhall Dental Practice on 17 January 2014 and found that the provider was not complying with three of the essential standards relating to cleanliness and infection control, supporting workers and quality monitoring. We judged that this had a minor impact on people using the service and required the provider to make improvements. The provider told us they would be compliant by the end of May 2014 and so we inspected the location again on 17 June 2014.

We found that a defective piece of equipment that had originally presented an infection risk had been replaced. We also found that a revised system for storing sterilised instruments had been introduced that complied with the Department of Health (DH) guidance.

Staff received appropriate professional development. The provider had scheduled staff appraisals to take place in the week following our inspection. There were formalised records to show when staff received appropriate training and updates.

The provider had implemented a yearly planner method of scheduling audits and key events. An infection control audit had identified a number of actions which were to be tested again at a follow-up audit later in the year. A patient satisfaction survey was planned for the month following our inspection.

When we inspected Woodhall Dental Practice on 17 January 2014 we found that people were provided with information about their treatment and they were asked for their consent. One person who was visiting the practice on the day of our inspection told us, “[The dentist] explained about the different sorts of fillings I could have and compared the benefits of each type and the costs.” Another person told us, “I was asked if I wanted to go ahead and of course I agreed. I signed the NHS forms.”

People’s needs were assessed and treatment was planned and delivered in line with those individual needs. One person told us, “I have to complete a form with my medical history which I discuss with the dentist.” Another person said, “[The dentist] is very good at putting me at ease. I feel in control and can tell them to stop if I need to have a break.”

Emergency oxygen, medicines and an automatic external defibrillator were available.

The instrument decontamination process was not in accordance with Department of Health guidance.

Staff were not supported to carry out their role effectively and safely because there were no formal arrangements for training, professional development or appraisal.

There were no auditing arrangements in place to help the provider to monitor and manage risks to people's health and welfare.

The people who use the service told us that they were happy with the dental care provided. We were told that one person had followed their dentist to this practice from another because they were so good. They also said that they had encouraged their family to join this practice. We were told that their family were also happy with the care given.

We were told that the practice was clean and friendly and that ‘you can’t fault it’. One person told us that they don’t know a dentist that cleans teeth like their dentist does. We were told that the patients were offered a choice between a private service and one that is funded by the NHS and given full details of the cost of both. All the people we spoke with told us that their health was always checked prior to any treatment being given.

We were told that the practice is clear about the service it provides.