We carried out an announced comprehensive inspection on 21 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

All Smiles Dental Practice is a dental practice providing private dental care for adults with a small NHS contract to provide care for children. Where private treatment is provided some is provided under a fee per item basis and some under a dental insurance plan. The practice is situated in a converted domestic property.

The practice has three dental treatment rooms, one on the ground floor and two on the first floor. There were two separate decontamination rooms, one on the ground floor and one on the first floor, where cleaning, sterilising and packing dental instruments takes place. There is also a reception and a waiting area on both floors as well as other rooms used by the practice for office facilities and storage. The practice is open from 8.45am to 5.30pm Monday to Friday and closes for lunch each day from 1.00pm to 1.45pm.

The practice has two dentists who are able to provide services including the provision of dental implants (a dental implant is a metal post that is placed surgically into the jaw bone to support a tooth and endodontic (root canal) treatment. They are supported by three dental nurses, a trainee dental nurse, a dental hygienist and a practice manager. Other staff included a dedicated receptionist.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

Before the inspection we sent CQC comment cards to the practice for patients to complete to tell us about their experience. We also spoke with patients on the day of our inspection. We received feedback from 41 patients. These provided a very positive view of the services the practice provides. Patients commented on the high quality of care, the friendliness and thoughtfulness displayed by staff, the cleanliness of the practice and the professionalism of all staff.

Our key findings were:

• Patients commented that they received excellent care, staff went above and beyond what was expected, were professional at all levels and appointments were easily available and flexible.

• The practice was visibly clean and well maintained.

• The practice had suitable facilities and was well equipped to treat patients and meet their needs, with the exception of the availability of a hearing loop which was purchased following our inspection.

• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).

• We found that staff reported incidents and accidents which were investigated and learning implemented to improve safety. There was a log of significant events in place which helped to identify any themes or trends and illustrate what actions had been taken.

• We found that risks were assessed and mitigating actions implemented where appropriate. However the practice did not have a fire risk assessment in place but this was undertaken after our inspection.

• The practice had available medicines and equipment for use in a medical emergency which were in accordance with national guidelines.

• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).

• Governance arrangements were in place for the smooth running of the service.

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

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the refrigerator temperature is monitored and recorded.

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

We used a number of different methods to help us reach a judgement on this service. These included talking with three patients who used the service, two dental nurses, one dentist and the practice manager. We also looked at records. These included treatment plans, records of meetings and information about how the service operated. We looked at information from surveys and audits undertaken by the provider to assess the quality of the service.

We found that the practice was well managed, clean and organised in a way which kept patients at the centre of the way they operated.

Patients told us they received the treatment they wanted in an efficient and organised way. They said they were involved in decision making about their treatment and were able to express their views about the service provided. One patient told us, “I’m made aware of the costs with a written treatment plan. It’s then up to me to decide.”

Patients said they always found the environment to be clean and tidy and said that staff wore the right protective equipment when treating them. We saw that the practice had a robust infection control policy and that staff were proactive in implementing it.

The provider had an effective system in place to monitor and improve the service provided to patients.

We saw that confidential information such as patient records were stored securely.

Patients told us they were always welcomed by a member of staff when they arrived at the surgery. They said they were satisfied with the treatment they received.

Patients told us they were involved in all aspects of their treatment and made decisions’ accordingly.

Other patients said they found the practice easy to access and the environment very clean.