We carried out this announced inspection on 25 January 2018 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. NHS England provided information which we took into account.

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 dental facility was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this dental facility was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this dental facility was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this dental facility was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

Devonport Devon Educational Facility is in Plymouth and is a NHS training clinic for the Peninsula Dental School Students. As the service is provided by dental students in training, supervised by experienced dentists, all care and advice provided by the dental students is free of charge to all patients. The dental school aims are to improve education, improve health and reduce health inequalities.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including spaces for patients with disabled badges, are available near the practice.

The dental team consists of dental school directors, a senior management team, clinical and educational leads, dentists, dental nurses, dental hygienists, dental hygienist therapists, clinical support workers, team leaders, technical officers, administrative staff and reception staff. There are annual cohorts of dental students, dental hygienist/therapist students and dental nurse apprentices receiving training at the facility. The dental school works in conjunction with Plymouth University. The practice has 40 dental chairs in five bays and three single surgery treatment rooms. The bays also provide a simulated dental learning environment when patients are not being treated.

The dental facility is owned by a social enterprise and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 at Devonport Dental Educational Facility was the director of clinical dentistry, who also holds the post of clinical lead at the facility and deputy head of Peninsula Dental School.

On the day of inspection we collected 18 CQC comment cards filled in by patients. This information gave us a positive view of the dental facility.

During the inspection we spoke with a range of staff from the Dental School and the University, which included directors, senior managers, clinical staff, administrative staff and students. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9am - 4.30pm (term time only).

Our key findings were:

• The facility was clean and well maintained.
• The facility had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The facility had systems to help them manage risk.
• The facility had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The facility had thorough staff recruitment procedures.
• The clinical staff ensured that students 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 facility had highly effective leadership. Staff and students felt involved and supported and worked well as a team.
• The facility asked staff, students and patients for feedback about the services they provided.
• The facility dealt with complaints positively and efficiently.

We identified areas of notable practice.

• The dental facility had an established active community engagement team working to build relationships with a range of community organisations and charities for vulnerable and disadvantaged people. For example, working in partnership with a number of charities supporting the homeless, ex-offenders, people suffering from mental health, addiction or substance misuse problems. The dental school had links with over 80 local groups. The dental facility was supporting a wide range of preventative health care initiatives, including oral heath training workshops for schools and workplaces. One notable initiative involved a ‘dental ambassador programme’ for adults with learning disability, developing a peer-led ambassador training programme, cascading out better understanding of oral health and helping develop oral health care skills among the target community. The Oral Health Foundation has recognised the dental ambassador programme as an example of good practice. The model for community oral health promotion, initiated at the dental school, is being rolled out in oral health schemes across the world. The dental school was rated first in the UK in the Guardian University league table for dentistry in 2017 for community value added score.

The practice also had

• Governance structures and staff actions which ensured candid reporting of incidents, including looking for antecedents to any near misses. This fostered a safety culture and demonstrated that the dental facility was a true learning organisation. For example, the dental school had adapted for use the World Health Organisation theatre checklist for all dental extractions. The checklist provided safety checks prior to the patient receiving local anaesthetic and before the start of dental surgery. The purpose of the checklist was to avoid ‘never events,’ such as wrong tooth extraction. The checklist was used as a learning and reflective practice aid following each procedure.