People told us that they were very happy with their dental treatment and that they were

always given options for treatment where possible and were able to make informed

decisions. Others told us they were given advice and information on oral health.

We examined a sample of patient records and we saw that they included medical histories

of the people concerned. We also saw that the records set out details of the treatment

people received.

We also saw that where people had arranged treatment privately they were given quotes

in advance, with a break down of the costs.

We saw that the contact details for emergency dentistry were displayed on the practice

door and in the reception area.

The surgery had effective systems in place for the decontamination of instruments. Staff

had been trained to follow infection prevention and control precautions.

The staff were aware of their responsibilities with regard to safeguarding both vulnerable

adults and children. Staff stated that they would have no hesitation in referring issues to

the local authority.

We carried out an announced comprehensive inspection on 23 January 2017 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

Midsomer Dental Care Limited is a dental practice providing predominantly NHS treatment for adults and children. They also provide some private treatment. Midsomer Dental Care was established in Midsomer Norton over 50 years ago. The practice is an adapted modern premises with treatment rooms all located on the ground floor. There is car parking close to the practice and the practice is wheelchair accessible to all patient areas.

The practice employs five dentists, one hygienist, eight dental nurses (who also cover reception duties and have lead roles for other specific areas) and a cleaner.

Treatment fees are displayed on the practice website and in the surgery.

The practice opens Monday 08.30-17.00, Tuesday 08.30-19.00, Wednesday 09.00-17.30, Thursday 09.00-17.00, Friday 09.00 with a variable closing time. The practice seeks to see patients in need or emergency dental treatment within 24 hours. There are arrangements in place to ensure patients receive urgent dental assistance when the practice is closed. This is provided by an out-of-hours service. Out of Hours instructions for emergency dental care can be found on the practice website, via the practice answerphone or by calling NHS 111 (if not registered with practice).

One of the two principal dentists is also the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. 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.

The inspection was carried out by a lead inspector and a dental specialist advisor.

Before the inspection, we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience of the practice.

We received feedback from 47 patients. In addition we spoke with two patients on the day of our inspection. Feedback from patients was positive about the quality of care, the caring nature of all staff and the overall high quality of customer care. They commented that staff put them at ease and listened to their concerns. They also reported they felt proposed treatments were fully explained them so they could make an informed decision which gave them confidence in the care provided.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Effective leadership was provided by the two principal dentists.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• Premises appeared well maintained and visibly clean.
• Good cleaning and infection control systems were in place and the practice followed published guidance.
• The treatment rooms were well organised and equipped, with good light and ventilation.
• There were systems in place to check all equipment had been serviced regularly, including the autoclaves and the X-ray equipment.
• The practice had a safeguarding lead professional and effective processes in place for safeguarding adults and children.
• There was a policy and procedure in place for recording adverse incidents and accidents.
• The dentists and dental hygienist provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The dentist used Loupes – these enable the clinician to have a magnified view of the operation site thus enabling accuracy of treatment.
• The practice had a system to monitor and continually improve the quality of the service; including through a programme of clinical and non-clinical audits.
• Patients could access treatment and urgent and emergency care when required.
• Staff had received training appropriate to their roles and were supported in their continuing professional development by the practice owners.
• Staff we spoke with felt well supported by the practice owners and were committed to providing a quality service to their patients.
• Information from 47 completed Care Quality Commission (CQC) comment cards and speaking to patients gave us a positive picture of a friendly, caring, professional and quality service.
• The practice reviewed and dealt with complaints according to their practice policy.

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

• Review the sterilisation of dental equipment in line with current HTM 01 05 guidelines Review the manual dismantling of syringes and consider changing to a safer sharps system.
• Review arrangements for the management of privacy and dignity for surgery three and consider the provision of an entry door.
• Review the arrangements for the storage of local anaesthetic in treatment rooms so that is maintained in the original packaging until use.
• Review the labelling and use of appropriate colour coded clinical waste bags under sinks in treatment rooms.
• Review the arrangements for the decanting of items such as amalgam or composite capsules so that expiry dates are present in the treatment rooms.
• Review the arrangements for stock rotation to ensure that no out of date stock or products are available in treatment rooms.
• Review the access arrangements for the emergency oxygen and readiness for immediate use.
• Review the need for marking a radiation designated ‘safe zone’ area in the passage outside of surgeries three and four.