We carried out this announced inspection on 3 January 2019 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.

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

Green Tree Dental is a well-established practice based in Cambridge that provides mostly NHS dental treatment. The dental team includes three part-time dentists, two dental nurses and a practice administrator. There are two treatment rooms.

The practice opens on Mondays to Thursday from 9am to 5pm, and on Fridays from 9am to 1pm.

There is level access for people who use wheelchairs and those with pushchairs, and on street parking nearby.

The practice is owned by an individual who is the principal dentist. 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 28 CQC comment cards completed by patients. We spoke with the principal dentist, a dental nurse and the receptionist.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring and professional service.
• The practice appeared clean and well maintained, and infection control procedures met nationally recommended guidance.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff felt supported and told us they enjoyed their work.
• The practice proactively sought feedback from staff and patients, which it acted upon.
• The practice took complaints and concerns seriously and responded to them appropriately to improve the quality of care.
• Recent recruitment difficulties had impacted on the availability of appointments for some patients.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use
• Review the practice’s protocols to ensure audits of radiography and infection prevention and control are undertaken at recommended intervals to improve the quality of the service.
• Review the fire safety risk assessment to ensure fire hazard management is wide ranging and effective.

During our inspection on 08 May 2013 we spoke with four people who told us they were satisfied with their care and treatment and that they had been spoken to politely by reception and dental staff whenever they attended the practice. They told us that the dentist had given them appropriate explanations and information about their treatment.

Care records showed people had been included in decision making and that their treatment had been adequately recorded.

Not all staff had received safeguarding training, although there were arrangements in place for all staff to receive this training. The policies for safeguarding children and for vulnerable adults did not include which guidelines the surgery was following, or refer to the Local Authority published guidelines.

We found suitable and appropriate infection control process were in place to ensure people were not exposed to the risks of cross infection and that the appropriate published guidelines had been followed.

The premises were clean and had been well maintained. We saw that there were suitable arrangements in place to reduce the risks of fire.