We carried out an announced comprehensive inspection on 12 January 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

Bedford Dental Practice is a general dental practice situated in the Riverfield area of Bedford. It provides treatment under the NHS or privately, and as well as a full range of general dentistry also offers tooth whitening and short-term orthodontics (a term used to describe quick orthodontic treatments that usually only affect the front teeth. These types of systems can use transparent trays instead of conventional braces to effect simple tooth movements).

The practice is situated on the ground floor of a purpose built building with a car park and disabled access.

The principal dentist is 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.

We received feedback on the service from 13 patients, either by way of them filling in a CQC comment card or in person. They were overwhelmingly positive about the service offered, and made particular reference to the friendliness of the whole team, and how they were made to feel at ease by the staff.

Our key findings were:

• Staff demonstrated a good knowledge of how to raise a safeguarding concern, and the situation in which that may be required.

• Essential standards in decontamination as outlined in the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices.’ published by the Department of Health were being exceeded.

• The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.

• The practice had monthly team meetings to discuss the running of the practice, any complaints and learning opportunities.

• Governance arrangements were in place for the smooth running for the practice, including the use of clinical audit to highlight areas that could be improved.

• The practice kept comprehensive dental care records and regularly audited the quality of the records to ensure that they were suitably detailed.

• Feedback from patients described the practice as friendly and caring. Several patients commented on how well the staff dealt with the challenges of treating young children.

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

• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Consider more robust scheduling of particular cleaning tasks in the practice to ensure that all aspects are being carried out appropriately.

This inspection took place on 3 February 2015 as part of our national programme of comprehensive inspections.

Bedford Dental Service is owned by Basudev Enterprises Limited and provides mainly NHS primary dental care and a small amount of private dentistry to patients in Bedford and surrounding villages. There are four associate dentists supported by two dental hygienists and six dental nurses. The practice opens Monday to Fridays plus Saturday mornings with evening appointments available four days a week. The provider who is the CQC registered manager, Dr Basudev, is referred to throughout this report as the principal dentist. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

Prior to our inspection we provided some CQC comment cards for patients to complete about their experience of the practice. A total of 12 comments cards were received and we found that patients had made positive comments about the practice and were very satisfied with the care and treatment they received from the staff. Patients said dentists took time to explain their dental needs to them and treated them with compassion and professionalism. We spoke with five patients on the day of the inspection who also said that staff were respectful and helpful.

Our key findings were:

• There were systems to identify, investigate and analyse patient safety incidents and share learning throughout the team. X-ray equipment at the practice had been serviced, maintained correctly and was only operated by qualified staff. Other items of equipment were serviced and maintained regularly. Staff recruitment procedures were effective.
• The dental care and treatment provided to patients followed current guidelines. Patients were given appropriate information to support decisions about their treatment and oral health. The practice kept detailed clinical records of assessments and treatments plans. There were systems in place to refer patients for specialist treatment and share information appropriately between dental practices. Staff were supported in their continuing professional development (CPD) and were meeting the requirements of their professional registration.
• Patients we spoke with or who completed CQC comments cards told us they had very positive experiences of dental care provided at the practice. Patients had confidence in the staff, were involved in treatment decisions and were treated with kindness and respect.
• A range of dental services were available to NHS patients and a small number of private patients. Patients (including those with a disability) had access to treatment including urgent and emergency care when they required it. There was an accessible complaints system in place.

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

• Ensure there is an effective system in place to review the risk assessments at appropriate intervals.

• Infection control systems should be strengthened by reviewing cleaning procedures and infection control policies to ensure they are fit for purpose. Checks completed on all the autoclave machines each day should be recorded to demonstrate that these items are functioning safely.

• Ensure that all policies and procedures within the practice are accessible to staff and fit for purpose.
• Establish systems to ensure that staff are kept informed and involved in service developments and quality improvements.
• Review the opportunities available to all patients to feedback their experience of using the service so that it can be used in a constructive way to benefit the service.
• Review the leadership structure so that the roles and responsibilities of staff are clearly defined and shared within the team.
• Improve safety and security of storage for clinical waste and sharps boxes.

During our visit to Bedford Dental Practice on 24 October 2012 we spoke with four people who were waiting to see one of the dentists or the dental hygienist. They told us that the dentist or the hygienist always clearly explained their treatment to them and ensured they understood their options and had the opportunity to ask questions and make choices. One person said “I have had appointments at a lot of the dentists locally and this dentist is very good at explaining what is needed and why”.

People we spoke with told us that they were satisfied with the treatment that they received and the records confirmed that the detail of the treatment provided and given was recorded appropriately.

All areas were clean and tidy and people were complimentary of the decor. The practice was easily accessible to people with mobility problems.

People told us that staff were friendly and polite and treated them respectfully at all times.