We carried out an announced comprehensive inspection on 7 December 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

Accrington Road Dental Center is situated in Blackburn, Lancashire. The practice offers mainly NHS dental treatments to patients of all ages and also offers private treatments. The ratio of NHS to private is approximately 60% / 40%. The services include preventative advice and treatment, routine restorative dental care and dental implants. They also hold an NHS contract for orthodontics and minor oral surgery.

The practice has eight surgeries, a decontamination room, two waiting areas and a reception area. The reception area, main waiting area and five surgeries are on the ground floor along with accessible toilet facilities. The smaller waiting area, decontamination room and three surgeries are on the first floor. There are staff facilities and storage on the second floor.

There are 10 dentists (one is an orthodontist and one is an oral surgeon), one dental hygienist, 11 dental nurses (four of whom are trainees), two patient co-ordinators and a practice manager. Many of the dental nurses also cover reception duties.

The opening hours are Monday and Wednesday 9:00am to 8:00pm, Tuesday and Thursday 9:00am to 5:00pm, Friday 8:00am to 5:00pm and Saturday 9:00am to 1:00pm.

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.

During the inspection we received feedback from 38 patients. The patients were positive about the care and treatment they received at the practice. Comments included staff were welcoming, friendly and respectful. They also commented the surgeries were clean and hygienic, they felt listened to and any concerns were addressed.

Our key findings were:

• The practice was visibly clean and uncluttered.
• The practice had systems in place to assess and manage risks to patients and staff including health and safety and the management of medical emergencies.
• Staff were qualified and had received training appropriate to their roles.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• We observed patients were treated with kindness and respect by staff.
• Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• The practice had a complaints system in place and there was an openness and transparency in how these were dealt with.
• Patients were able to make routine and emergency appointments when needed.
• The governance systems were effective.
• There were clearly defined leadership roles within the practice and staff told us they felt supported, appreciated and comfortable to raise concerns or make suggestions.
• Decontamination and sterilisation procedures were effective. However, staff were unclear about the checks for the ultrasonic bath and autoclave.
• Staff were carrying out procedures to reduce the risk of legionella but the practice had not carried out a legionella risk assessment.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health namely 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 the storage of environmental cleaning equipment giving due regard to national guidance.
• Review its responsibilities with regard to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and ensure all substances used in the practice are listed in the COSHH folder.
• Review the availability of a legionella risk assessment and implement the required actions, giving due regard to the guidelines issued by the Department of Health namely Health Technical Memorandum 01-05: Decontamination in primary care dental practices and the Health and Safety Executive –Approved Code of Practice L8: Legionnaires’ disease (The control of legionella bacteria in water systems).
• Review the practice's recruitment policy and procedures to ensure Disclosure and Barring Service (DBS) checks for all new staff are sought at the point of employment.

People were happy with the care and treatment they received at Accrington Road Dental Centre. One person told us, "I have been a patient here for a long time. I have no complaints about anything“. A comment from a recent patient survey was, "They dealt with my emergency by a same day appointment, appropriate treatment and referral". People spoken with told us they were always able to get appointments to suit their needs.

People told us they were provided with good information about the treatments and the costs and they had been given enough time and information to make a decision about their treatment. We observed staff at the practice treated people in a kind, professional, friendly and respectful manner.

People told us they felt safe when visiting the practice. One person commented "I was nervous when I came but the staff were very understanding and always accommodate my needs”.

On the day of the visit we found the practice to be safe, clean and reasonably well maintained. People told us the practice was always very clean.

Staff told us that they felt well supported and we found that they had the necessary skills and training to undertake their role in a safe and appropriate manner.