We carried out an announced comprehensive inspection on 5 October 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

Acacia Dental Practice is situated in the town of Bromyard in Herefordshire. It provides private and NHS dental treatment for all age groups. It has been operated by Acacia Dental Practice Limited, a limited company, since 2013. In 2014 the practice moved from first floor premises with no parking on site to a converted bungalow to provide more accessible ground floor premises with on-site parking.

The company secretary 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 has three dentists (one of whom is the registered manager), a dental hygienist, a dental therapist (who was also a dental hygienist), two dental nurses and a trainee dental nurse. The registered manager and clinical team are supported by a receptionist/administrator.

The practice has two dental treatment rooms and a separate decontamination room for the cleaning, sterilising and packing of dental instruments. The waiting room is separate from the reception area which helps provide privacy when staff are dealing with patients at the reception desk or on the telephone.

The practice is open from 9am to 5pm Monday to Friday and closes for lunch from 1pm to 2pm.

Before the inspection we sent Care Quality Commission comment cards to the practice so patients could give us their views about Acacia Dental Practice. We collected 14 completed cards and spoke with two patients at the practice. Patients said they were pleased with the service they received and that the practice team were professional, friendly and respectful. Some patients mentioned that their dentist listened to them, explained everything clearly for them and that they felt safe. Those that commented on cleanliness confirmed that the practice was clean and tidy. We reviewed the results of the practice’s NHS Friends and Family Test for the nine months from January 2016. These were positive and showed that 100% of the patients who took part were extremely likely or likely to recommend the practice.

Our key findings were:

• The practice was visibly clean and feedback from patients confirmed this was their experience. National guidance for cleaning, sterilising and storing dental instruments was followed.
• The practice had suitable safeguarding processes and staff understood their responsibilities for safeguarding adults and children.
• The practice had processes for dealing with medical emergencies.

• Dental care records provided clear information about patients’ care and treatment and patients received written treatment plans.
• Staff received training appropriate to their roles and were supported to meet the General Dental Council’s continuous professional development requirements.

• Patients were able to make routine and emergency appointments when needed and were gave us positive feedback about the service they received.

• The practice used the NHS Friends and Family Test, to enable patients to give their views about the practice. Results during 2016 showed that patients would recommend the practice. Staff had opportunities to contribute their views through daily discussions, staff meetings and annual appraisals.

• The practice had policies and procedures to help them manage the service but these needed to be reviewed and consolidated. Recruitment arrangements did not ensure that all the required information was always obtained for staff employed.

• The practice used audit as a means to monitor quality in a range of areas but did not routinely carry out repeat audits to ensure improvements had taken place.

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

• Review the storage of dental care products and medicines requiring refrigeration including recording the refrigerator temperature.

• Review the use of rectangular collimators when taking X-rays.

• Review the practice's recruitment arrangements so an effective process which fully reflects relevant legislation and guidance is in place and the required information in respect of persons employed by the practice is held.

• Review the availability of a hearing loop to assist those who use hearing aids and information about translation services for patients who do not speak English as their first language or who use British Sign Language.

• Review the recording arrangements for some aspects of practice management including incoming safety alert information, fire safety arrangements and mandatory training.

• Review the practice’s audit arrangements particularly for radiography, infection prevention and control and dental care records to help improve the quality of service. The practice should check all audits have documented learning points, that improvements can be demonstrated and that repeat audits are used to confirm this.

• Review the practice’s policies and procedures to make information easier to access, to avoid duplication and the possibility that staff may refer to incorrect or out of date information.