We carried out an announced comprehensive inspection on 29 July 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.

Background

Zen Clinic is a dental practice situated in purpose built premises within a medical centre in Colchester, Essex.

The practice has four treatment rooms, a waiting room with a separate children’s area and a reception area. Decontamination takes place in a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

The practice has a principal dentist, two associate dentists, three dental hygienists, three dental nurses and a practice manager. The dental nurses and the practice manager also carry out reception duties.

The practice is registered with the Care Quality Commission (CQC) as an organisation. At the time of our inspection the practice did not have a registered manager. 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. Health and social care providers who are not registered as individuals are required to have a registered manager.

The practice offers NHS and private general and cosmetic dental treatments to adults and children. The opening hours of the practice are 8.30 am to 6 pm Monday, Tuesday and Wednesday, between 8.30 am and 7 pm on Thursday and 8.30am to 4.30pm on Fridays. The practice offers private appointments on Saturdays between 9am and 12noon.

We left comment cards at the practice for the two weeks preceding the inspection. 26 people provided feedback about the service in this way. All of the comments spoke highly of the dental care and treatment that they received and the professional, attentive and caring attitude of the dentists and dental nurses.

Our key findings were:

• There was an effective complaints system and learning from complaints was used to make improvements where this was required.
• The practice was visibly clean and clutter free and Infection control practices met national guidance.
• There were a number of systems in place to help keep people safe, including safeguarding vulnerable children and adults.
• Dental care and treatments were carried out in line with current legislation and guidelines.
• Patients reported that they were received excellent dental care and they were treated with kindness and compassion and staff were understanding, polite and helpful.
• Patients were involved in making decisions about their care and treatments.
• The practice provided a flexible appointments system and could normally arrange a routine appointment within a few days or emergency appointments mostly on the same day.
• The practice kept medicines and equipment for use in medical emergencies. These were in line with national guidance and regularly checked so that they were fit for use.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Governance arrangements were in place for the smooth running of the service.
• Patient’s views were sought and used to make improvements to the service.

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

• Submit an application to CQC for a relevant person to be registered as the manager for the service.

We carried out an announced comprehensive inspection on 1 July 2015 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.

Background

Zen Clinic Limited offers NHS and private dental care services to patients of all ages. The services provided include preventative advice and treatment and routine restorative and cosmetic dental care. The practice has waiting areas and treatment rooms on the ground floor.

The practice has five dentists, three who work part time; they are supported by three dental hygiene therapists, dental nurses, receptionists and a practice manager. The principal dentist 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.

The practice is open on Monday and Tuesday between 8.30pm and 6pm, Wednesday 8.30am to 5pm, Thursday 8.30 to 7pm, Friday 8.30 to 4.30pm and Saturday 9am to 12 noon. The practice closes from 1pm to 2pm Monday to Wednesday, 1pm to 2.30pm on Thursday and 12.30pm to 1.30pm for lunch and training.

We spoke with three patients who used the service on the day of inspection and reviewed 30 completed CQC comment cards. Patients we spoke with and those who completed comment cards were positive about the care they received about the service. Patients told us that they could get appointments that suited them, including same day appointments for urgent dental treatments. Patients commented very positively about all members of staff. They told us that dentists, dental nurses, receptionists and dental hygienists were always welcoming and helpful. They also reported that dentists and hygienists explained treatments in a way that they could understand, listened to them and were caring and kind.

Our key findings were:

• The practice recorded and analysed significant events and complaints but did not cascaded learning to staff.
• Where mistakes had been made patients were notified about the outcome of any investigation and given a suitable apology.
• There were systems in place to check all equipment had been serviced regularly, including the suction compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• Staff had received safeguarding and whistleblowing training and knew the processes to follow to raise any concerns.
• Patient’s care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation.
• There were sufficient numbers of suitably qualified staff to meet the 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, 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 and waiting times were kept to a minimum.
• There was an effective complaints system and the practice was open and transparent with patients if a mistake had been made.
• The practice was well-led and staff felt involved and worked as a team.
• The practice sought feedback from staff and patients about the services they provided.

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

• Ensure effective systems for manual instrument cleaning are in place.
• Ensure all staff follow an agreed written procedure with regular audits.
• Ensure that the practice cascades learning to staff from recorded and analysed significant events and complaints.
• Ensure lessons learnt from audits and feedback from patients should be appropriately disseminated to ensure all staff receive the information.

At our last inspection on 08 February 2013 we had moderate concerns in relation to the lack of proper arrangements in place to deal with foreseeable emergencies, decontamination and infection control, recruitment procedures and supporting staff.

The purpose of this visit was to check if improvements had been made. We did not speak with people who used the service on this visit.

We found that the provider had made improvements.There were arrangements in place to deal with foreseeable emergencies to ensure people's safety and welfare.

A new decontamination room had been commissioned that met essential standard requirements and appropriate guidance had been followed to protect people from the risk of infection.

The provider had put effective recruitment and selection processes in place to ensure suitable staff were employed and staff received appropriate professional development and support to carry out their role.

Steps had been taken to implement effective systems to monitor the quality and safety of service provision and improve outcomes for people who use the service.

Following our inspection of the service we spoke with three people by telephone who had received treatment at the dental clinic on the day of our visit.

All the people we spoke with were very complimentary about the service and treatment they had received at Zen Clinic and would recommend the dental clinic to family and friends. Comments included “I am very happy with the service I have received so far, I have no complaints” and “I have been going to Zen Clinic for four to five years and have received an excellent service, everybody is very helpful.”

Everyone we spoke with told us they were provided with information about their treatment in a way that they could understand and this included treatment options and related costs. They all felt very involved in their treatment. One person told us “Treatment options and related costs are always explained thoroughly.”

We found that the surgery was clean and tidy. However we saw that the provider did not have effective systems in place to reduce the risk and spread of cross infection.

We found that the service had not been effectively managed and the provider had not taken appropriate steps to identify this. The provider did not have established systems in place to regularly assess and monitor the quality of the service or identify, assess and manage any risks in relation to the safety of the service provided. This included the recruitment, training and supervision of staff.