We carried out an announced comprehensive inspection on 7 October 2015 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.

Bayston Hill Dental Practice provides NHS dental treatment to children and adults and has a General Dental Service (GDS) contract in place. There are approximately 1800 patients who attend the practice. The practice is situated in Bayston Hill, Shrewsbury. Bayston Hill Dental Practice has two dentists, one works three days per week and the other one day a week, the practice is closed every Friday. The practice team includes a dental nurse, a trainee dental nurse, a practice manager/dental nurse and a receptionist. The practice team is supported by the providers’ general manager, who works across all four of the provider locations.

The practice is all on the same level, on the first floor above a parade of local shops. The practice is accessible by the use of stairs and is not suitable for patients with reduced mobility. The reception area is separated from the waiting room via a counter desk. Staff managed patient privacy by requesting that only one patient at a time approaches the counter desk. The practice has two dental treatment rooms. The practice has a separate room for the decontamination and cleaning, sterilising and packing of dental instruments.

Before the inspection we sent Care Quality Commission (CQC) comment cards to the practice for patients to use to tell us about their experience of the practice. We collected 36 completed cards. These provided extremely positive views of the service the practice provides. Patients told us the practice was either excellent or very good, staff were welcoming, that the dentists were professional, caring, understanding of their anxieties, thorough and fully explained any procedures and the fees/costs. Several patients specifically commented that the dentists put them at ease and had allayed their fears. We spoke with four staff members all understood the needs of their patients living with dementia illnesses and those with learning disabilities. They understood their responsibilities under the Mental Capacity Act (2005).

The practice business is operated by a partnership, Hanover Dental Practice with two partners, both partners are dentists. The practice has a registered manager with the CQC. 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 (amended 2014) and associated Regulations about how the practice is run.

Our key findings were:

• The practice had systems for dealing with significant events and accidents and staff understood their responsibilities for providing a safe service.

• The practice was visibly clean and tidy.

• The practice had systems, medicines and, with the recent purchase of an Automated External Defibrillator (AED), equipment for the management of medical emergencies and staff were trained to know how to deal with these.

• The practice had safeguarding processes and staff understood their responsibilities for safeguarding adults and children.

• Clinical records included the essential information expected about patients’ care and treatment including treatment plans and consent to care and treatment.

• The practice was committed to staff education and development. Staff received training appropriate to their roles and were encouraged and supported in their continued professional development (CPD).

• The practice received very few complaints but had a clear system for handling and responding to these.

• Patients who completed Care Quality Commission comment cards were pleased with the care and treatment they or their family member received and were complimentary about the whole practice team.

• The practice had well organised governance and leadership arrangements and an open door policy which made staff feel valued and listened to.

• The practice had open and supportive leadership and staff were happy in their roles, professional and enthusiastic.

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

• Install a lock on the waiting room storage cupboard in accordance with the Control of Substances Hazardous to Health (COSHH).
• Consider the constraints of storage areas at the practice and environmental cleaning arrangements in order to be in line with the National Patient Safety Agency (NPSA) guidance: Specifications for cleanliness in the NHS: Guidance on setting and measuring performance outcomes in primary care medical and dental premises.
• Reduce the risk of cross infection post sterilisation of instruments by use of instrument pouches and implement changes to the local decontamination unit sink overflow seal.
• Reconsider the storage arrangements for medicines for use in the event of an emergency to ensure they are stored securely but are readily accessible to staff.
• Where the two oxygen cylinders are stored consider guidance in respect of oxygen hazard signage.
• Mitigate any risks identified regarding the lack of electrical socket availability within the reception area.
• Review and update the Equality Act 2010 assessment of the building and make firm plans to improve the facilities where reasonable based on the findings of this. This should include a review of the suitability of the staff toilet and the installation of hand wash facilities as well as the lack of a patient toilet
• Clearly advertise within the practice brochure that the practice does not have a patient toilet facility.
• Consider staff training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLs).
• Implement timely improvements to the dental treatment room (surgery 1) identified as requiring refurbishment.