We carried out an announced comprehensive inspection on 16 May 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

Cromwell Place Dental Practice is situated in the market town of St Ives. The service provides a range of dental services to NHS and private patients of all ages and has been under new ownership for approximately one year. The practice has its own small car park and is situated close to public car parks. The practice has four dental treatment rooms, a decontamination room, a reception area and waiting area. Three treatment rooms with an additional small waiting area are on the first floor of the property and may not be accessible to patients with limited mobility.

The practice opens weekdays from 8.45am until 5pm and provided some treatment for private patients on a Saturday according to need. Two dental partners run the practice with assistance from five associate dentists (two of whom provide only specialist services) and two dental hygienists. They are supported by a practice manager, five dental nurses (one of whom is a trainee) and two receptionist/administrators.

One of the partners 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.

We received feedback from 35 patients either in person or on CQC comments cards from patients who had visited the practice in the two weeks before our inspection. The cards were all positive and commented about the caring and helpful attitude of the staff. Patients told us they were happy with the care and treatment they had received and that staff were very reassuring.

Our key findings were:

• Staff had been trained to handle emergencies. Access to appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• The practice appeared very clean and well maintained.
• Infection control procedures were robust and the practice followed published guidance.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• An accident and incident reporting system was in place, had been followed but still required strengthening so that all incidents and accidents could be reviewed and learning identified and shared.
• Patients told us they were able to get an appointment when they needed one and the staff were kind and helpful.
• Governance arrangements were in place for the smooth running of the practice although these systems were still being embedded by the team and some improvements were still needed to strengthen the audit process and monitor the completion of staff training.
• Information from 33 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.
• A complaints process was in place and was followed in a timely way. Patients received an apology if they had a poor experience.
• Staff felt valued and enjoyed working at the practice.

You can see full details of the regulations not being met at the end of this report.

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

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005, Gillick competencies and the reporting of injuries diseases and dangerous occurrences regulations (RIDDOR) and ensure all staff are aware of their responsibilities.

• Review the requirements for general environmental risk assessments so that identified risks are safely managed for the safe protection of staff, patients and visitors to the practice.

• Review the practice's recruitment policy and procedures to ensure there is a clear guide on the staff who require Disclosure and Barring Service checks. Review procedures followed for maintaining accurate, complete and detailed records relating to the employment of staff.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development and there is a system in place to monitor the completion of training.
• Review the practice’s audit protocols for radiography and infection control. Check that all audits have documented learning points and the resulting improvements can be demonstrated.
• Review the options to enhance communication with patients who have hearing difficulties and consider the introduction of a hearing loop.
• Review the arrangements to monitor the ultrasonic washers to seek assurance that a robust decontamination process is completed.