We carried out an unannounced comprehensive inspection on 12 February 2016 due to information of concern being shared with the Care Quality Commission.

We asked 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 regulation.

Background

Tiverton Dental Centre is a dental practice providing mainly NHS and some private treatment for both adults and children.

The practice is situated in Tiverton town centre. The practice has three dental treatment rooms based over two floors and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The practice had one treatment room on the ground floor enabling level access for patients who had mobility problems.

The practice employs six dentists, one hygienist, two dental nurses, four trainee dental nurses of whom two are enrolled on recognised training courses and two are on induction and a practice manager. The practice’s opening hours are 8am to 1pm and 2pm to 6pm Monday to Thursday and 8.30am to 1pm and 2pm to 5pm on Friday. There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

There was no registered manager at the time of our inspection at this location. We were told that the current practice manager was going through the CQC registration process to become 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 inspection was carried out by a lead inspector and a dental specialist adviser.

Our key findings were:

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.

• The practice appeared clean and maintained although some areas of the practice were cluttered.

• Infection control procedures generally followed published guidance.

• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.

• Staff reported incidents and kept records of these which the practice used for shared learning.

• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence guidelines.

• The service was aware of the needs of the local population and took these into account in how the practice was run.

• Patients could access treatment and urgent and emergency care when required.

• Staff recruitment files contained essential information in relation to Regulation 18, Schedule 3 of Health & Social Care Act 2008 (Regulated Activities) Regulations 2015.

• Staff received training appropriate to their roles and were supported in their continued professional development by the practice manager.

• Staff we spoke to felt supported by the practice manager and were committed to providing a quality service to their patients

• Information from 14 patients gave us a positive picture of a friendly and professional service.

• The practice manager, although recently appointed to this position, provided effective leadership for staff working at the practice.

• The practice reviewed and dealt with complaints according to their practice policy.

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

• Ensure that risks in relation to fire safety are fully identified and mitigated.

• Review infection control protocols to ensure that the packaging of processed instruments follow published guidelines.

• Ensure that a new Legionella risk assessment is carried out.

• Declutter treatment rooms and storage areas of the practice.

We visited the practice on one day, during the practice's normal opening hours. The provider practices as a dentist along with three other dentists. The practice had both adults and children registered.

We met and spoke with the practice manager and the dental professionals on duty. We looked at records which showed people were consulted about advised treatments. Ongoing dental care was monitored via discussion between the person and their dentist during their appointments. We were satisfied people were protected from the risks of unsafe or inappropriate care and treatment and the provider had robust systems in place to monitor quality at the practice.

Following our inspection we contacted, with their permission, people who had recently attended the practice. We asked people about their experiences including the approachability of staff, information given to them about their treatment and their opportunities to contact the provider to comment upon their experiences of using the practice. We received four responses to questionnaires we sent to twelve people via email. Overall, people were satisfied with the treatment they had received. Comments included “the staff were friendly and helpful” and “I have always been informed of different treatments and the decisions have been jointly made by myself and the dentist”.

People who use the service told us they were happy with the treatment provided by Tiverton Dental Centre. They were given clear explanations of what treatment they required. People told us they were offered a choice of treatment options.

People spoken with told us staff were helpful and polite. One person, who has been registered at the practice for over 35 years, said “There are a good bunch of girls here, I have confidence in my dentist”.

People who use the service told us they received a prompt delivery of care. They told us that they were able to make routine appointments easily. People told us if they required an emergency appointment the practice provided this usually within 48 hours.

We saw that the public areas of the practice were clean and well maintained. The practice was in the process of refurbishing the public areas of the service to improve patient satisfaction and better working conditions for staff.