We carried out an announced comprehensive inspection on 30 March 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

Alford Dental Care is a dental practice situated in the small market town of Alford in Lincolnshire.The practice is in a building that has been adapted for the purpose of dentistry and is all on the ground level. There are three treatment rooms, reception desk, separate waiting area, a small staff area at the back of the reception with a staff kitchen, a patient toilet, staff toilet and changing area and a manager’s office. There is also a room that is used for storage accessible to staff only. Neither the patient or staff toilet is adapted for those patients that are disabled or with limited mobility. The entrance to the practice is from the street and can be easily accessed by those patients with limited mobility, wheelchair access, or pushchairs via a ramp.

There are three dentists working in the practice alongside five dental nurses and one receptionist. The dental nurses also cover reception duties. The practice employs their own cleaner.

The owner and provider 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 provides NHS and some private dental treatment to adults and children. The practice is open Monday to Thursday from 8.30am to 5.45pm and Friday from 8am to 2pm. Monday to Thursday the practice closes for lunch from 1pm to 1.45pm.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We received feedback from 38 patients about the services provided.

Our key findings were:

• There was appropriate and well maintained equipment for staff to undertake their duties.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in place and staff had access to personal protective equipment.
• The practice had the necessary equipment to deal with medical emergencies, and staff had been trained how to use that equipment. This included oxygen and emergency medicines.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control.
• Policies and procedures at the practice were kept under review.
• Dentists involved patients in discussions about the care and treatment on offer at the practice. Patient recall intervals were in line with National Institute for Health and Care Excellence (NICE) guidance.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks.
• Patients were treated with dignity, respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum where possible.
• The practice was well-led; staff felt involved and worked as a team.
• Governance systems were effective and policies and procedures were in place to provide and manage the service.
• Staff had received safeguarding training and knew the processes to follow to raise any concerns.
• All staff were clear of their roles and responsibilities.
• There was a process in place for reporting and learning from significant events and accidents.
• The practice had not completed a Disability Discrimination Act audit although they had identified improvements that could be made such as grab rails in the patient toilet.
• Complaints and incidents were not shared with all staff to discuss learning and outcomes although learning from complaints and incidents were documented and thorough.
• Rubber dam was not always used for root canal treatment as documented in guidelines issued by the British Endodontic Society.
• Audits were completed however these were not on an individual clinician basis; they were on a practice level so that learning points could be shared.
• Not all staff were able to explain how the principles of the Mental Capacity Act 2005 applied to their roles.

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

• Review its responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.
• Review the practice’s system for reviewing incidents and complaints with a view to preventing further occurrences and feedback to all practice staff.
• Review whistleblowing policy to give staff the option of contacts outside of the organisation or practice such as the Care Quality Commission (CQC) or General Dental Council (GDC).
• 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 practice responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review its audit protocols to document learning points that are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.
• Review the practice's protocols for patients signing to confirm updated medical history checks.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the storage of dental care records to ensure they are stored securely.

We spoke with four people who used the service. They generally spoke very positively about the care and treatment they had received. They told us they were provided with sufficient information for them to make a decision about their treatment. One person told us, "Staff are very good at explaining things. They always go through any treatment I need” and another person said, “Brilliant service, my family have been coming here for years.”

Evidence showed people were protected from the risk of infection because appropriate guidance had been followed. People we spoke with told us the practice was very clean and staff always wore protective clothing when treating them.

Staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed to maintain their qualifications. People we spoke with told us staff were always polite and respectful and provided a good standard of care.

The practice had an effective system to regularly assess and monitor the quality of service that people received. The practice had a complaints policy and took account of complaints and comments to improve the service.