We carried out this announced inspection on 22 June 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not have any relevant information to share with us regarding this dental practice.

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

Allestree Dental Practice is located in premises in the north of the city of Derby and provides both NHS and private dental treatment (50/50) to patients of all ages.

The practice is located on the first floor with a flight of steps to access the practice. However, alternative access arrangements are available. There is time limited car parking available in the local area. This includes parking for blue badge holders.

The dental team includes four dentists; two hygienists; five qualified dental nurses; one trainee dental nurse; one receptionist and one practice manager. The practice has three treatment rooms; none of these are located on the ground floor.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Allestree Dental Practice is the principal dentist.

On the day of inspection we collected 38 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, one hygienist and four dental nurses including the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday: 8:45 am to 7 pm; Tuesday: 8:45 am to 5 pm; Wednesday: 8:45 am to 7pm; Thursday: 8:45 am to 5 pm and Friday: 8:45 am to 5 pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which followed published guidance.
• Patients provided positive feedback about the service and the staff.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Dentists said they did not always use rubber dam when completing root canal treatment. This was not in-line with the guidance issued by the British Endodontic Society
• The practice had systems to help them manage risks in the practice, particularly with regard to health and safety.
• The practice had suitable safeguarding processes. Staff had been trained and knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took measures to protect their privacy and personal information.
• The appointment system met patients’ needs. Patients said they could get an appointment that suited them.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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

• Review the practice's waste handling protocols to ensure waste is stored and disposed of in accordance with relevant regulations taking into account guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).

• 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.

• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

• Review the practice's protocols for medicines management and ensure that all medicines that have a use by date accurately reflect the identified date.

• Review the risk assessments relating to the use of equipment within the premises, and consider whether moving some equipment would reduce those risks.

• Review the use of rectangular collimation on X-ray machines to reduce the risk factors to as low as reasonably practicable.

People we spoke with told us it was easy to make appointments and were given choices about when these were. One person told us "they always fit you in on the same day if it's an emergency".

Everyone told us staff were friendly and approachable and spoke to them in a respectful way. Two people told us they were "very happy" with the way they were dealt with and the general approach of staff.

People we spoke with were complimentary about the service they received. One person told us “it’s spot on”, another said the service was “brilliant” and told us “everything is done perfectly”. Another person told us they were nervous about visiting dentists and described their care and treatment as “really good” and said the way everything was explained helped calm them down. Another person told us the service was “very good” and described it as “service with a smile”, whilst another described it as “absolutely first class” and told us the dentist was “thorough”.

People told us the premises were always clean and our own observation confirmed that they were hygienic. One person told is “it’s very clean” and another described the cleanliness as “spot on”.