We carried out this announced inspection on 17 July 2018 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

All Saints Green dental clinic is a well-established practice based in Norwich that provides both private and NHS treatment. The dental team includes eight dentists 15 nurses, two hygienists and three receptionists who provide services to about 20,000 patients. There are nine treatment rooms

The practice opens Monday to Friday between 8.30am and 5.30 p.m.

There is level access to the premises for people who use wheelchairs and those with pushchairs. The practice has a small car park, with a specific space for disabled patients.

The practice is owned by an individual who is the principal dentist there. 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 39 CQC comment cards completed by patients, and spoke with another two. We spoke with the principal dentist, the practice manager, one associate dentist, eight dental nurses and one 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, professional and high-quality service.

• The practice had effective systems to help ensure patient safety. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control, and responding to medical emergencies.

• Risk assessment was robust and action was taken to protect staff and patients.

• The practice had made excellent adjustments to meet the needs of its disabled patients including a wheelchair lift to the lower floor and a tracking mechanism in each treatment to accommodate patients who needed to be hoisted onto the dental chair. Special blue lights had been installed around the reception desk to make it more visible to sight impaired patients.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• Patients received their care and treatment from well supported staff, who enjoyed their work.

• Members of the dental team were up-to-date with their continuing professional development and were supported to meet the requirements of their professional registration.

• The practice had effective leadership and a culture of continuous audit and improvement.

• The practice asked staff and patients for feedback about the services they provided. Staff felt involved and worked well as a team.
• One dentist did not use the rubber dams to protect patients’ airways.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

We spoke with people after they had attended their appointments with the dentist. They all told us they felt respected by the staff and were fully involved in the decisions regarding their dental treatment and aftercare. One person told us “This is an extremely professionally run dentist clinic, and the staff have very high standards when dealing with patients”.

They told us they felt safe in the surgery and confident in reporting any issues of concern to their dentist. With one person commenting “They cannot improve here, it’s perfect as it is, and the staff helped me overcome my fear of dentists”.

People told us they thought all areas within the practice were of a very high standard of cleanliness.