We carried out this announced inspection on 31 May 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.

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

Mr Adrian Yellon – Bedwell is in Stevenage, Hertfordshire and provides NHS (95%) and private (5%) treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes four dentists, five dental nurses, one dental hygienist, two receptionists, one practice manager/dental nurse and the practice cleaner. The practice has four treatment rooms.

The practice is owned by an individual who is the principal dentist 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 spoke with two patients and received three CQC share your experience reports. We also looked at Friends and Family feedback from July 2017 to April 2018 and noted these were wholly positive with 100% of patients who responded stating they were likely or extremely likely to recommend the practice to friends or family.

During the inspection we spoke with three dentists, two dental nurses, two receptionists and the practice manager/dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 8:30am to 7pm.

Tuesday from 8:30am to 8pm.

Wednesday from 8:30am to 8pm.

Thursday from 8:30am to 5pm.

Friday from 8:30am to 5pm.

Saturdays from 9am to1pm.

Our key findings were:

• Strong and effective leadership was provided by an empowered practice manager.
• The practice had infection control procedures which reflected published guidance. The practice had not conducted six monthly auditing with regard to their infection control procedures.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were mostly available with the exception of a paediatric reservoir bag and clear face masks which were immediately ordered.
• The practice had systems to help them manage risk.
• The practice staff 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs. Extended hours appointments were available three evening a week and Saturday mornings.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice's Legionella risk assessment and implement any recommended actions, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’
• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’ In particular review the practice’s systems for environmental cleaning taking into account current national specifications for cleanliness in the NHS.
• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.

When we inspected the dental service provided by Mr Adrian Yellon at Bedwell on 25 June 2013, we found that people were given information about their treatment and their consent was sought. One person using the service on the day of our inspection said, "They are very good at communicating and very clear on the price.” Another person said, “They had a look and asked for my opinions and if I wanted to go ahead.”

People said they felt involved in their treatment plan and had the opportunity to choose the right treatment for their needs. One person said, “I am involved and I feel in control. Today, I decided I am doing nothing about a damaged tooth and I am going to leave it a few months because I was told I didn’t need an extraction if I was not experiencing pain.”

We saw that the practice was equipped to deal with medical emergencies and had relevant medication and oxygen in place.

The practice operated decontamination and infection control methods according to relevant guidance. One person using the service said, “... very clean, they always have gloves and masks on.”

Staff were supported in their role because the provider had on-going appraisal and training arrangements.

The provider took a proactive approach to improving the service. Independent dental consultants were commissioned to review various aspects of the practice, such as infection control and clinical practice, in order to ensure that a safe and effective dental service was provided.