We carried out this announced inspection on 20 February 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

Abbey House Dental Practice is in Stone and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available in public car parks near to the practice.

The dental team includes seven dentists, three visiting specialist dentists, a clinical dental technician, three dental nurses, three trainee dental nurses, one dental hygiene therapist, three receptionists and two managers. The practice has four treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Abbey House Dental Practice is the principal dentist.

On the day of inspection, we collected 43 CQC comment cards filled in by patients.

During the inspection we spoke with four dentists, one dental nurse, one trainee dental nurse and the two managers. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 9am to 7.30pm.

Tuesday from 9am to 5.30pm.

Wednesday from 7.30am to 7pm.

Thursday from 9am to 5.30pm.

Friday from 9am to 5.30pm.

Saturday by appointment only.

Our key findings were:

• Strong and effective leadership was provided by the principal dentists and an empowered management team. Staff felt involved and supported and informed us this was a good place to work.
• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff. The practice held safety data sheets for all products, but had not completed risk assessments in accordance with their control of substances hazardous to health policy.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Safeguarding contact details and flow charts were displayed throughout the practice.
• The provider had thorough staff recruitment procedures.
• The principal dentists had implemented a pay scale chart which rewarded enhanced development with a structured pay increase and time served at the practice with additional holiday entitlement.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The provider renovated this premises in 2012 to expand and accommodate specialist services such as endodontics, dental implants, orthodondontics and sedation. This enabled patients to receive more advanced treatments in surroundings they were familiar with and reduced waiting times for these complex treatments.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health. They routinely referred patients to their dental hygiene therapist through a clear care pathway.
• The appointment system took account of patients’ needs. The practice offered extended opening hours, opening late on Monday and Wednesday, opening early on Wednesday and opening on Saturday.
• The provider had effective leadership and a supportive culture of continuous improvement. The dental nurses had been supported to complete enhanced dental nursing qualifications in radiography, oral health education, topical fluoride application, impression taking, scanning, sedation nursing and implant nursing.
• The provider asked staff and patients for feedback about the services they provided. Feedback was analysed, shared with the team and improvements made were displayed in the waiting room patients to read.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements. However, the closed-circuit television cameras protocols did not fully reflect published guidelines.

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

• Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken for all products.
• Review the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained. In particular ensuring the air conditioning unit is serviced annually in accordance with manufacturers guidance.
• Review the practice’s protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.

We undertook this review to check on the care and welfare of people receiving dental care at this service. We also looked at the cleanliness of the practice and the infection control practices that were in place.

We spoke to a total of seven people who used the service. This included adults, children and people with special needs. We also spoke to some people who were nervous about attending the dentist. Everyone we spoke to was pleased with the care they received. They felt that the staff were polite and showed them respect. Comments included, "Really good", "The nurse held my hand and made me feel relaxed" and "Both dentists are brilliant". A parent told us that the dentist had made their child "feel like a princess".

People told us that the dentist fully explained their treatment options and that they made the decision about the treatment they wanted. People also said that costs were fully explained to them. Comments included, "They were very clear over the options and I decided the treatment I wanted'.

We looked at all areas of the dentist surgery and we saw that all areas looked clean and hygienic. People told us they were provided with protective glasses and aprons and that the dentist and nurses wore protective equipment. We observed that the dentist had infection control practices in place but we identified that there had recently been errors in dating of clean instruments. Due to the high turnover in the use of clean instruments there was little likelihood that equipment would have been used after the date it was guaranteed to be safe.