We carried out an announced comprehensive inspection on 23 June 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.

Castle and Costa is the trading name of a partnership set up by Conrad and Audrey Costa. There is one dentist, a practice manager and two part-time dental nurses.

The practice manager 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.

The practice provides domiciliary dental services to over 100 care homes in the Norfolk area, and also to vulnerable people living in their own homes. Referrals come mostly from care homes, GPs, speech and language therapists, and people who refer themselves. All treatment is funded by the NHS. A range of dental services is offered including examination, oral health promotion, the treatment of dental infection and toothache, fillings, and denture provision. Patients requiring x-rays or more complex work are referred to other services, such as the community dental teams. The practice is not commissioned to provide recall services.

Our key findings were:

• Staff had an excellent understanding of the needs of patients who could not give consent, and had received extensive training in this. We consider this to be of notable practice.
• Staff were clearly committed to providing good dental care to vulnerable people.

• The practice recorded and analysed significant events and complaints, and shared learning with staff.
• Staff had received safeguarding and whistleblowing training and knew the processes to follow to raise any concerns.
• Staff had been trained to handle emergencies, and appropriate medicines and life-saving equipment were readily available.
• Infection control procedures were in place and the practice mostly followed published guidance.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines, best practice and current legislation.
• Patients received clear explanations about their proposed treatment and were involved in making decisions about it.
• Staff had an excellent understanding of the Mental Capacity Act and regularly applied its principles in their everyday work.
• The practice was well-led: staff felt involved and worked as a team.
• Governance systems were effective and there was a range of audits and patient surveys to monitor the quality of services.

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

• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health – (Health Technical Memorandum 01-05: Decontamination in primary care dental practices) in relation to the use of plastic aprons, the use of long handled brushes, monitoring water temperature, emptying the autoclave reservoir each day and keeping dental instruments moist whilst in transit.
• Ensure that amalgam is filtered and disposed of correctly. 
• Regularly record the temperature inside the car when transporting medicines to ensure it does not exceed 25 degrees centigrade.
• Improve the security of controlled drugs when stored in the vehicle.
• Ensure that patients’ risk scores for gum disease, oral cancer and dental decay are recorded in their dental care records.
• Ensure that all the practice’s policies and procedures are dated, and show evidence of regular review.