We carried out this announced inspection on 5 December 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

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

Designer Smiles is a denture clinic located in Worcester which provides private dentures and mouth guards to patients of all ages since June 2015. The practice is sited on the ground floor of a building which is co-located with a dental laboratory to ensure that appliances can be made on site to minimise waiting times for patients.

There is level access for people who use wheelchairs and pushchairs. The practice consists of a reception area, a patient waiting room, an accessible patient toilet, one dental treatment room and a decontamination room for the cleaning, sterilising and packing of dental instruments. Car parking spaces, including one for patients with blue badges, are available in the dedicated car park next to the practice.

The dental team includes one dentist, one managing director / dental laboratory technician and one practice manager who covers the reception, chaperones in the treatment room and is the decontamination room lead.

The practice is owned by an individual who is the managing director / dental laboratory technician there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected three CQC comment cards filled in by patients and looked at results from recent practice patient satisfaction surveys. This information gave us a positive view of the practice.

During the inspection we spoke with the managing director / dental laboratory technician, one dentist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Tuesdays: 9am to 5pm

The telephone line is redirected to the managing director in the co-located dental laboratory on Monday, Wednesday, Thursday and Friday from 9am to 5pm to enable appointment bookings.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were mostly available, with the exception of some sizes of clear face masks and a defibrillator or risk assessment for not having a defibrillator. The missing items and a defibrillator were immediately ordered on the day of our inspection.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs. The practice opened one day per week for denture / mouth guard clinics and did not provide an emergency dental facility, patients were signposted to their general dental practitioner for this service. The phone lines were manned Monday to Friday from 9am to 5pm.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team. The team met informally at the beginning of each clinic and on a monthly basis, following our inspection we were sent a copy of a documented staff meeting and were advised that future monthly meetings would be documented.
• The practice asked staff and patients for feedback about the services they provided. We were informed that one staff member had not received a formal appraisal since the practice opened in 2015, but this was scheduled for December 2017.
• The practice had systems to deal with complaints positively and efficiently although they had not received any complaints since they opened in 2015.

There were areas where the provider could make improvements. They should:

• Review the practice's protocols for completion of dental care records taking into account evidence-based guidance and standards provided by the Faculty of General Dental Practitioners for clinical examination and record keeping. A record-keeping audit is advised.
• Review the staff supervision protocols and ensure an effective process is established for the on-going appraisal of all staff.