We carried out an announced comprehensive inspection on 15 September 2015 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

Mayden dental practice provides general dentistry and other specialist dentistry such as orthodontics. The practice provides private services for patients in New Romney, Kent and the surrounding area.

The practice staff included a dentist, a dental therapist, two dental nurses and receptionists. Dental services are provided Monday 9am to 6pm, Tuesday 9am to 5.45pm, Wednesday and Thursday 8.30am to 6pm and Fridays 9am to 2pm. There are appointments available on Tuesday evenings and Saturday mornings for patients who have difficulty attending during normal working hours.

We talked to five patients. They believed that the practice offered an excellent service and staff were efficient, helpful and caring. All commented that staff always had time to spend with them. They commented that it was fairly easy to get appointments and that if they needed emergency treatment staff made time to fit this in. They did not feel that staff were pressured to complete procedures and staff took time to explain what they were doing. They said that staff treated patients with dignity and respect.

Our key findings were

• There were effective systems to reduce the risk and spread of infection. We found that all the treatment rooms and equipment appeared clean.
• There were systems to check all equipment had been serviced regularly, including the compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• Dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.
• The practice ensured staff maintained the necessary skills and competencies to support the needs of patients.
• The practice kept up to date with current guidelines.
• Patients were provided with information and were involved in decision making about the care and treatment they received. We observed staff to be were kind, caring, and worked hard to put patients at their ease.

There were areas where the provider could make improvements and should

• Review staff training and availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role

.

• Complete regular staff appraisals and complete any identified actions

• Review the governance systems to ensure that they are effective in assessing, monitoring and improving the quality and safety of the services provided.

• Carry out audits relating to the quality of X-ray images giving due regard to the recommendations set out in IR (ME) Regulations 2000.

During our inspection on 13 December 2013 we found that the provider was not meeting the requirements of the DOH Health Technical Memorandum 01-05: Decontamination in primary care dental practices. The provider did not have an effective system to regularly assess and monitor the quality of service that people receive nor an effective complaints system available.

Following our visit the provider sent us an action plan, which stated they would be compliant with this regulation by June 2014.

During this visit we found that infection control procedures had been implemented appropriately. However, the damaged chair had not been repaired or replaced. We were told by the provider that the chair would be replaced in the near future and that the treatment room was not being used to provide care and treatment to patients until the replacement had been completed. We saw that sink in the decontamination room remained unchanged and continued not to comply with the DOH Health Technical Memorandum 01-05: Decontamination in primary care dental practices. We saw plans for the whole of the decontamination room to be refurbished by the end of October. However, we found that there was no risk assessment in place to show how the risk of spreading infection could be minimised whilst the sink was still in use.

The provider had an effective system to regularly assess and monitor the quality of service that people receive and there was an effective complaints system available.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

People were made aware of the complaints system.

The provider had made suitable arrangements for the regulated activities to be carried on during her absence.

Patients told us they were satisfied with the service provided by the practice. One person said “They (staff) are nice friendly people who put you at your ease”.

We saw that treatment options were discussed and sufficient time given for patients to decide which treatment option they wanted to receive. However, patients told us that they were not always provided with a written treatment plan or written details of costs of treatment.

Although we found the location to be clean and tidy, we found that good infection control practices were not taking place. We found the Practice did not have processes in place, such as audits and reviews.

Processes around staff training were not robust. Training records were incomplete and there were no suitable arrangements in place to support staff to update their knowledge and skills. For example, not all staff had been trained in safeguarding vulnerable adults and children.

There was no comprehensive system in place to ensure the provider monitored and maintained the quality of service provision at the Practice.

We found the provider had not followed their policy when managing complaints.