We carried out a comprehensive inspection of Oasis Dental Practice on 9 January 2015. The practice is known locally as Pool Farm.

Pool Farm is a mixed dental practice providing NHS and private treatment. The practice caters for children and adults and is situated in a part of Hereford that has areas of social deprivation. Hereford has a significant Eastern European population and the practice team includes dentists who speak several European languages.

The practice is situated in a converted listed building which had been upgraded since our last inspection. The practice provides services on two floors and has a reception area on the ground floor. This is separate from the ground floor waiting room to provide greater privacy for patients when speaking with reception staff. The practice has seven dental treatment rooms and three decontamination rooms for cleaning, sterilising and packing dental instruments.

The practice has a full time practice manager who is registered with the Care Quality Commission as the registered manager. They are legally responsible for making sure the practice meets the regulations from the Health and Social Care Act 2008 relating to the quality and safety of care.

The practice has seven dentists and twelve multi-skilled dental nurses one of whom is the practice’s lead nurse. The dental nurse team also carry out reception duties and there are two further receptionists and a practice co-ordinator. There are two part time dental hygienists who provide preventative advice and gum treatments on prescription from the dentists working in the practice. A number of the dental nurses carry out extended duties including preventative fluoride applications and the provision of oral health education. Oasis had recently appointed a lead dentist to provide clinical leadership to the other dentists at the practice.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice. We collected 19 completed cards. These provided a positive view of the service the practice provides. Patients commented that the team were courteous, efficient and kind. Several wrote that they were seen on time and were pleased with their dental treatment. A number commented that the practice was clean and that they appreciated the recent improvements to the building.

Our key findings were:

• Staff reported incidents and kept records of these which the practice used for shared learning. The practice had enough staff to deliver the service.
• The practice was visibly clean and well maintained.
• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• The practice placed an emphasis on the promotion of good oral health and provided regular oral health instruction to patients.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).
• Information from 19 completed CQC comment cards gave us a positive picture of a friendly, professional service.
• The practice took into account any comments, concerns or complaints and used these to help them improve the practice.
• The practice manager and lead nurse were proud of the practice and their team. Staff felt well supported and were committed to providing a quality service to their patients.

The main reason for this inspection was to check what improvements had been made in the way information from complaints was used to improve the overall quality of the service. We also looked at other aspects of how quality and safety were monitored and maintained.

We found that following our last inspection improved supervision arrangements had been arranged for the dentists. They now had regular one to one supervision by the organisation's regional clinical advisor. These sessions included consideration of any complaints about that dentist as well as discussions about their training and development. Complaints were also discussed during practice meetings. The information recorded at the practice showed that there had been a reduction in the number of complaints the practice had received.

There were arrangements in place to assess and monitor the quality of the service and the safety of patients and staff.

This was a follow up inspection which we arranged at short notice (please note it was not unannounced as stated above). Our previous inspection was in February 2012. At that time we spoke to a number of people who used this dental practice. We did not speak to people using the service as part of this inspection but will do so again when we inspect during 2013. During our previous inspection we identified minor concerns regarding the health and welfare of people who used the service and moderate concerns regarding recruitment. We did this inspection to find out if improvements had been made.

We found that more information had been made available to people about the charges for their treatment. We also found that the arrangements for checking important safety alerts had been improved.

We looked again at how complaints were recorded and monitored. We found that some improvements had been made but that the provider needed to do more in this area. This was because they were not monitoring the reasons for complaints, identifying if there were common issues or evidencing that lessons had been learned from complaints that were upheld.

We looked at the personal files for two staff who had recently been appointed and saw that the required checks had been done. We have highlighted in our report some issues that the provider may find it useful to note regarding their recruitment procedures.

We spoke with six people who attend Pool Farm dental practice by telephone following our visit. Most people we spoke with were pleased with the service they received at the practice. One person described the service they received as “excellent”, another told us that their dentist was “gentle”. One person told us that they had not had a positive experience and we encouraged them to approach the practice manager about this.

We asked people if their dentist gave them clear information about the dental care and treatment they needed and any costs involved.. Some people said they had been given this information, but some were not sure. One person said they had a “bit of a shock” about the cost of their treatment.

We also spoke with people about how they felt the dental practice dealt with them and whether their privacy and dignity was respected. People said that they were treated well and some made a point of saying how friendly the reception staff were. People confirmed that their privacy was respected while their treatment was in progress.

People confirmed that the dentists and dental nurses wore protective clothing such as face masks and gloves. They said that they were usually given protective goggles to wear during their treatment. People told us they were happy with the general cleanliness and hygiene arrangements at the practice.

We looked at how the practice had dealt with complaints they had received. We found that there was not enough information to provide assurance that all aspects of people’s concerns had been considered or investigated. The practice was not consistent in making sure that people had their treatment and any costs involved explained to them clearly.

As part of our inspection of this service we checked information about the recruitment of staff and found that improvements were needed to make sure essential checks were done before people started work.