We carried out an announced comprehensive inspection on 3 October 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

The practice is located within a purpose adapted residential property in Westcliff on Sea, Essex and offers a range of NHS and private preventative, restorative and cosmetic dental treatments to adult patients and children.

The practice is open and offers appointments for patients between 8am and 5pm on Mondays Wednesdays, Thursdays and Fridays and between 8am and 8pm on Tuesdays.

The practice employs 12 dentists, 16 qualified dental nurses, two trainee dental nurses, two receptionists and a practice manager. Two dental hygienists provided services at the practice

The practice is registered with the Care Quality Commission (CQC) as an organisation. The practice manager is the registered manager. 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 has 11 treatment rooms, two waiting rooms and a reception area. Decontamination takes place in a dedicated decontamination room (Decontamination is the process by which dirty and contaminated instruments are bought from the treatment room, washed, inspected, sterilised and sealed in pouches ready for use again).

We received feedback from 26 patients who completed CQC comment cards prior to our inspection visit. We also spoke with six patients during our inspection visit. Patients made positive comments about the cleanliness of the premises, the empathy and responsiveness of staff, and the quality of treatment provided. Patients told us that staff explained treatment plans to them well. Patients reported that the practice had seen them on the same day for emergency treatment.

Our key findings were:

• The practice had systems in place for investigating and learning from complaints, safety incidents and accidents. Staff were aware of their responsibilities to report incidents.
• The practice was visibly clean and clutter free. Infection control practices were reviewed and audited to test their effectiveness.
• There were systems in place to help keep people safe, including safeguarding vulnerable children and adults. There were systems for assessing risks to the health, safety and welfare of patients and staff.
• There were systems in place to assess, monitor and minimise infection control risks, including the safe handling and storage of clinical waste. However we found that clinical waste was stored in unlocked bins.
• The practice had the recommended medicines and equipment for use in the event of a medical emergency. Records were maintained in respect of the checks carried out for these medicines and equipment.
• Staff undertook training in respect of their roles and responsibilities within the practice.
• Patients reported that they were treated with respect and that staff were polite and helpful.
• Patients were involved in making decisions about their care and treatments.
• The practice could normally arrange a routine appointment within a few days or emergency appointments mostly on the same day.
• Effective governance arrangements were in place for the smooth running of the service.
• Audits and reviews were carried out to monitor and improve services,
• Patient’s views were sought and these were used to make improvements to the service where these were identified.

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

• Review the practice’s waste handling policy and procedure to ensure waste is stored safely in accordance with relevant regulations giving due regard to guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).

We carried out this inspection to check on the improvements we told the provider that they must make to the service.

We saw that improvements had been made in all of the areas where these were required.

There were suitable arrangements in place for identifying and minimising the risks of abuse to people who were using the service. Suitable policies and procedures had been implemented and training had been sourced for staff. There was a range of information available for staff and patient's to raise awareness around safeguarding people who may be vulnerable from the risk of abuse.

Improvements had been made regarding the arrangements for minimising the risks of infection to people who used the service. Inappropriate window blinds and floor coverings had been replaced so that these areas were easily cleaned to minimise risks of cross infection. There were detailed schedules in place for the general and specific cleaning of equipment and premises. There were arrangements for checking that cleaning was carried out to a high standard so as to minimise risks of infection.

Improvements had been made regarding the arrangements for testing and improving, where necessary the quality and safety of the service. There was a system for auditing cleanliness and infection control practices, patient's records and checks to ensure that the equipment and premises were safe and suitable.

The service was compliant across each of the areas we looked at during our visit.

People we spoke with during our visit to the service in June 2013 told us that they were very happy with the care and treatment they received. People said that treatments were explained to them in a way that they could understand and that their consent was sought before any treatment commenced.

We saw that there were clear records in respect of the treatments provided. People's views and wishes were taken into account in the way that care and treatments were provided.

People we spoke with told us that they felt safe when using the service and that they had no complaints. There were procedures in place for recognising and reporting signs of abuse in children. However there were no procedures in place for safeguarding adults and staff had not undertaken any safeguarding training.

There were systems and procedures in place for minimising the risks of cross infection. However improvements were needed as areas within the practice were not maintained in line with current infection control guidelines. There was a lack of consistent monitoring to ensure that the systems for minimising the risks of infection were effective.

Staff were provided with opportunities to undertake relevant training so that they could deliver care and treatment safely. Staff we spoke with said that they felt supported by managers and that they had good training opportunities.

Overall improvements were needed to ensure that the safety and quality of the service was monitored effectively.