We carried out an announced comprehensive inspection on 29 November 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

Butterflies Dental Clinic is a general dental practice situated in the town of Stony Stratford, Buckinghamshire. It provides general dental treatment to adults and children funded privately.

The practice is situated in a converted period residence and as such wheelchair access could not be assured even though the treatment areas were on the ground floor of the building.

The practice had two treatment rooms, an X-ray room, reception area/waiting room and patient toilet on the ground floor. Upstairs are the staff areas including a dedicated decontamination facility (for cleaning and sterilising dental instruments) a kitchen/staff room and an office.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 from 37 patients from comment cards that we left at the premises for two weeks preceding the inspection. Patients were extremely positive about their experiences with the service.

Our key findings were:

• The practice was visibly clean and clutter free.

• Comments from patients indicated that the staff were kind and caring and were skilled at putting nervous patients at ease.

• The practice met the standards set out in national guidance regarding infection control.

• A routine appointment could be secured within a few days and emergency appointments would be seen on the day they contacted the service.

• The practice had policies in place to assist in the smooth running of the service.

• The practice had medicines and equipment to treat medical emergencies. These were in date with the exception of the oxygen. This was replaced following the inspection.

• The practice was monitoring the water temperatures to ensure the risk of legionella bacteria developing was minimal. However the system did not recognise that the temperatures recorded were below the required amount. This was due to error in the method by which they were taken.

• The practice performed appropriate pre-employment checks on new staff in line with regulation; however they were not always recording references.

• The practice used national guidance in the care and treatment of patients.

• Clinical audit was used as a tool to identify areas where improvements could be made. Infection control audits were not carried out at the recommended interval of six monthly.

• Equipment was serviced and validated in line with manufacturers’ guidance, with the exception of the ultrasonic cleaner which was decommissioned at the time of the inspection and the practice switched to an alternative method of cleaning.

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

• Review the use of rectangular collimator to further reduce the dose of radiation when taking intra-oral X-rays.

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

• Review the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance

• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded.

We did not speak to people who use the service as we were looking at procedures at the practice during this inspection.

We spoke with people who use the service and they told us that they were happy with the service offered by the practice. One person told us that they had previously feared going to the dentist and that their current dentist was brilliant. We found concerns in relation to infection control at the practice.