We carried out a comprehensive inspection of D A & C Houston & Associates - Milton Road on 9 January 2015.

The group of practices are comprised of four separate treatment centres, all conveniently located on the same site. All four buildings have been adapted and are compliant with the Disability Discrimination Act (DDA) 1995. They have a total of 26 treatment rooms; four of these are specifically for hygienist treatments. D A & C Houston & Associates - Milton Road has 23 dentists, of which two are the principal dentists and partners (provider); three visiting specialists who attend the practice regularly; six dental hygienists and a large number of dental nurses and reception staff.

There is a dedicated Local Decontamination Unit (LDU) in each building. The practice provides both NHS and private dental treatment to adults and children.

The practice offers conscious sedation for nervous patients and is a training practice for a foundation dentist. A foundation dentist is someone who has completed the academic part of their training and is completing their practical training and consolidating their learning under the mentorship of an experienced dentist.

The partner dentists are legally responsible for making sure the practice meets CQC requirements as is the registered manager.

We found the practice staff were friendly, welcoming and informative. The provider has created an atmosphere where excellence is promoted. We saw evidence of good communication and team work.

We spoke with five patients who used the service on the day of our inspection and reviewed 22 CQC comment cards that had been completed by patients prior to the inspection. The patients we spoke with were very complimentary about the service. They told us they found the staff to be extremely person-centred and felt they were treated with respect. The comments on the CQC comment cards were also very complimentary about the staff and the service provided. We were also shown feedback from other professionals who work with the practice and they reported the practice was patient centred and sought to provide dental treatment in line with the latest guidance.

During the inspection we toured the premises and spoke with a majority of staff on duty that day. This included the principle dentist. To assess the quality of care provided by the practice, we looked at practice policies and protocols and other records. Our key findings were as follows:

• The practice provided safe, effective and caring treatment which met patients’ needs.

• There were systems in place for staff to report incidents. There were sufficient staff on duty to deliver the service. There was enough equipment available for staff to undertake their duties and we saw the premises were in a satisfactory state of repair. It was clean and tidy.

• Patient’s needs were assessed and care was planned and delivered in line with current best practice guidance. This included the promotion of good oral health. We saw evidence staff had received training appropriate to their roles and further training needs were identified and planned through an effective appraisal system.

• The patients we spoke with and all comment cards we reviewed indicated patients were consistently treated with kindness and respect by staff. It was reported that communication with patients and their families, and access to the service and to the dentists was good. Patients reported good access to the practice with emergency appointments available the same day.

• The practice had procedures in place to take into account any comments, concerns or complaints that were made to improve the practice.

• The practice had two accessible and visible principle dentists and staff on duty told us they felt supported by the principles. Staff reported patients were at the heart of the practice. This included the promotion of good oral health. Staff had received training appropriate to their roles and there was an effective appraisal system in place.

What people who use the service say.

We spoke with five patients visiting the practice. The patients were a mixture of newly registered patients; patients who had been at the practice for a number of years and those who had been referred for specialist treatment offered in the practice. Those who were not newly registered had used the dental services between two and ten years.

The majority of comments made by patients were positive and praised the practice staff. For example they spoke about: receiving excellent care and treatment; the efficiency of the service (one person told us another had been able to get an emergency appointment on the same day) and about the caring attitude of dentists.

We heard and observed how some patients found access to the practice and appointments easy and how telephones were answered after a short period of waiting.

Patients told us their privacy and dignity was always respected during consultations and they found the reception area was generally private enough for most discussions they needed to make.

Patients spoken with told us the practice was always kept clean and tidy and the practice felt fresh, modern and spacious. Patients told us they liked the waiting areas as they did not feel cramped.

During our inspection we spoke with eight people who used the service, four out of the 15 dentists employed, four out of 15 dental nurses and one out of three hygienists employed. We also looked at seven treatment records of people who used the service.

We spoke with eight people who used the service, from different areas of the practice, who told us they had no complaints about the service provided. Some of the comments people made were; “top marks, absolutely fine, I couldn’t wish for anything better.” Another person said the dentist is “excellent, explains everything at each stage of the process” and they “relax you.” Another person said “Brilliant, I used to hate dentists before coming here” and “good, I like this one”.

We found the practice was well organised and structured. Staff felt well supported and had opportunities for further development in specialised areas of dentistry.

We found that people felt involved in their treatment and had confidence in the treatment provided. People received treatment consistently from the same staff, which provided an individualised approach.

The provider had taken precautions to protect vulnerable people from abuse. Staff were aware of the signs and knew how to report concerns. Staff also knew their role in protecting people from the risk of infection. They had received appropriate training and followed the appropriate guidance to reduce the risk.