We carried out an announced comprehensive inspection on 30 January 2017 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Cheddar Dental Practice is situated in a Victorian building that has been extend and modernised to provide up to date equipment and facilities. It is near the centre of the village and is accessible by bus. The practice provides NHS general and restorative dental services to children and adults and some private patients.

The facilities include seven surgeries and a purpose built, dedicated decontamination/ sterilisation room plus spacious waiting areas. The facilities are fully equipped to cater for people of all ages and abilities. Children are made welcome with play areas in each waiting room which have puzzles, books and games to keep them entertained. The practice has wheel chair access to the three ground floor surgeries. There is a hearing loop at Reception and information materials can be provided in large font. Access to translation services is available on request

Fees for both NHS and private were displayed in information leaflets for patients available in the practice and on the practice website. There are arrangements in place to ensure patients receive urgent dental assistance when the practice is closed. This is provided by an out-of-hours service which can be accessed by calling NHS 111. These arrangements are displayed in the practice and on a telephone answering service.

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. The registered manager is also one of the three trained dental nurses in the practice.

The practice is open Monday – Friday 8.30am – 12.30pm and 1.45pm - 5.30pm. The practice is closed at weekends but the out of hours emergency arrangements are displayed on the website. Contact information is available from the practice telephone answering service.

We reviewed 52 CQC comment cards that had been left for patients to complete prior to our visit. In addition we spoke with six patients on the day of our inspection.

Feedback from patients was positive about the care they received from the practice. They commented the staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained them so they could make an informed decision which gave them confidence in the care provided. Patients we spoke with and the comment cards told us staff were kind, caring, competent and put patients at their ease ,

Our key findings were:

• There were systems in place to help ensure the safety of staff and patients. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control and responding to medical emergencies.
• We observed and were told by staff the practice ethos provided patient centred dental care in a relaxed and friendly environment.
• Leadership was provided by the principal dentist and an empowered lead receptionist.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The dental practice had effective clinical governance and risk management processes in place; including health and safety and the management of medical emergencies.
• Patient care and treatment was delivered in line with evidence-based guidelines, best practice and current legislation including National Institute for Care Excellence (NICE) guidelines.
• Patient dental care records were electronic, detailed and comprehensive.
• The practice had a comprehensive system to monitor and continually improve the quality of the service; including through a detailed programme of clinical and non-clinical audits.
• The use of digital radiographs to help explain necessary treatment to patients while in the chair.
• Premises appeared well maintained and visibly clean. Good cleaning and infection control systems were in place. The treatment rooms were well organised and equipped, with good light and ventilation.
• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment
• There were sufficient numbers of suitably qualified staff who maintained the necessary skills and competence to support the needs of patients.
• Staff were up to date with current guidelines, supported in their professional development and the practice was led by a proactive principal dentist.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required with information for out of Hours service clearly available.
• Staff received training appropriate to their roles and were supported in their continuing professional development (CPD) by the company.
• Staff we spoke with felt well supported by the principal dentist and lead receptionist and were committed to providing a quality service to their patients.

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

• Review the practice 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 and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance with particular attention to the Annual Infection Control statement.

• Review the Legionella risk assessment and staff access to training about legionella awareness.

• Review maintenance records regarding the electrical hard wiring of the practice
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting.