We carried out an announced comprehensive inspection on 6 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

First Dental is a dental practice providing general dental services on a NHS (predominantly) and private basis. The service is provided by four dentists (one of whom is a specialist orthodontist). They are supported by seven dental nurses (one of whom is a trainee), a practice manager and a receptionist. The dental nurses also carry out reception duties. Two of the dentists also carry out inhalation sedation at the practice for children.

The practice is located on a main road near local amenities and bus routes. There is wheelchair access to the practice. The premises consist of a waiting room, reception area, office, kitchen, staff room, storage room and four treatment rooms on the ground floor. The first floor comprises of a decontamination room, a storage room, two treatment rooms and an office. There is also an area for taking and developing X-rays on the ground floor. The practice opens at 8:50am on Monday to Friday and closing times vary between 1:30pm and 7pm.

The provider is registered with the Care Quality Commission (CQC) as an individual. 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.

Sixteen patients provided feedback about the practice. We looked at comment cards patients had completed prior to the inspection and we also spoke with three patients. The information from patients was overwhelmingly complimentary. Patients were positive about their experience and they commented that staff were friendly and polite.

Our key findings were:

• The practice was organised and appeared clean and tidy on the day of our visit. Many patients also commented that this was their experience.
• Patients told us they found the staff polite and friendly. Patients were able to make routine and emergency appointments when needed.
• An infection prevention and control policy was in place. We saw the decontamination procedures followed recommended guidance.
• The practice had systems to assess and manage risks to patients, including health and safety, safeguarding, safe staff recruitment and the management of medical emergencies. Some improvements were required in some of these areas.
• Dental professionals provided treatment in accordance with current professional guidelines.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• The practice had an effective complaints system in place and there was an openness and transparency in how these were dealt with.
• Staff told us they felt well supported and comfortable to raise concerns or make suggestions.
• The practice demonstrated that they regularly undertook audits in infection control, radiography and dental care record keeping. However, the audit in infection control was overdue at the time of our visit.
• Practice meetings were not held regularly and these should be used for shared learning.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as Public Health England (PHE).
• Review the current legionella risk assessment and implement the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance
• Review its responsibilities as regards to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.

• Review staff training to ensure that staff who are involved in conscious sedation have received the appropriate training (including refresher training) and skills to carry out the role giving due regard to guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.
• Review the protocol for completing detailed records relating to recruitment of staff. This includes ensuring recruitment checks, including references and proof of identification, are suitably obtained and recorded.

We carried out this inspection to check on the care and welfare of people using this service. To ensure that we had time to see and speak to staff working at the practice, as well as people visiting the service we arranged the visit in advance.

On the day of the inspection we spoke with the provider, staff members and three people who used the service.

The practice had a contract with the NHS to provide NHS dental care to people. People could choose to pay for private treatment which was outside the agreed treatments of the NHS.

We spoke to people who were attending the surgery for consultations or treatment. All of the people we spoke with told us they had used this surgery for a number of years and were happy with the treatment they received. They told us the staff were always pleasant, the practice was clean and tidy and appointments were arranged at a convenient time to them. Everyone we spoke with told us they were happy with the service and would recommend the practice to family and friends.