We carried out an announced comprehensive inspection on 8 March 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

Blue Sky Dental is a private practice located in the town centre of Chelmsford, Essex. The town has good transport links, there is limited on street parking and a public car park nearby. The practice offers specialist dental services only. The practice accepts NHS referrals for specialist dentistry but does not undertake any routine dentistry. The practice does not treat any patients under the age of 16 years old.

The practice team comprises of seven specialist dentists, a hygienist, three dental nurses and one trainee dental nurse. There was also one full-time receptionist.

We received feedback from 15 patients which was all positive about the care and treatment they received from all staff.

Our key findings were:

• The practice did not have robust or effective systems for reporting, recording and analysing significant events. There had not been any significant events identified in the last five years.
• The practice had a complaints policy in place. Complaints were acknowledged and dealt with and shared with relevant staff. However learning from complaints was not reviewed to help minimise recurrences.
• There was a lack of checking procedures to check that all staff who worked at the practice had up to date basic life support training.
• The practice had some systems to assess and manage risks to patients. Some of these were not followed consistently. There was no legionella risk assessment.
• Recruitment checks were inconsistent with the practice policy, for example, references were not taken, and proof of identification was not always provided.
• The practice had a defibrillator, emergency oxygen and emergency medicines available and all staff knew of their location.
• Staff had received safeguarding training and knew the procedures to follow to raise any concerns.
• There were sufficient numbers of suitably qualified staff to meet patients’ needs
• Infection control procedures were in place and the practice followed national guidance. Annual infection control audits had been carried out.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation.
• Patients received clear and detailed explanations about their proposed treatment, costs, options and risks. Patients were therefore able to make informed decisions about their choice in treatments.
• We observed that patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs whether they wanted to be seen urgently or for routine appointments.

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

• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.
• Review the arrangements for assessing and managing the risks of legionella.
• Review the arrangements for staff recruitment to ensure that all of the appropriate checks are carried out and records in respect of these are maintained.
• Review the arrangements for monitoring training, learning and development needs of individual staff members and have an effective process established for the on-going assessment and appraisal of all staff.
• Review the practice’s complaints policy to ensure complaints are recorded thoroughly and share learning outcomes.
• Review the way in which information is shared with staff to enable feedback. Implement a system of sharing information with and enabling feedback from staff.

We spoke with three people using the service who told us they were involved in making decisions about their treatment, and given oral health advice. People also told us that risks and benefits of treatment was explained to them and they were always asked to consent before any treatment was provided.

We reviewed electronic records of three people using the service, which showed a plan of their treatment and included the routine recall time appropriate for each person. One person told us: "They always explain to me my treatment options and I choose the treatment I want.”

People were provided treatment in a clean, hygienic environment. There were systems and processes to ensure that people were protected from the risk of infection.

We spoke with two staff members who told us they were very well supported by the provider in their role at Blue Sky Dental.

We were shown audits, and assessments performed by the provider that were used to monitor and check the quality of the service provided at the dental practice.