We carried out an announced comprehensive inspection on 22 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

The practice has an NHS contract and provides dental treatment for approximately 10,500 patients. General dentistry, together with restorative dentistry. It also provides private treatment.

There are four dentists (two male and two female), four dental nurses, two hygienists, one dental therapist, and two receptionists. The practice is open from 8am to 4pm on Monday to Friday. Outside of these hours emergency dentistry was provided by an out of hour’s service the details of which were visible from outside the practice and on the website.

We spoke with three patients who used the service on the day of our inspection and reviewed 20 CQC comment cards that had been completed by patients prior to the inspection. The patients we spoke with were complimentary about the service. They told us they found the staff to be friendly and informative. They felt they were treated with respect. The comments on the CQC comment cards were also very complimentary about the staff and the service provided. We also spoke with nine members of staff, including the principal dentist.

The practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

Our key findings were:

• Patients’ needs were assessed and care was planned and delivered in line with current professional guidelines.
• All equipment used in the practice was well maintained in accordance with the manufacturer’s instructions.
• The practice was visibly clean and well maintained. Infection control procedures were robust and the practice followed published guidance.
• The practice had enough staff to deliver the service. Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).
• Staff felt well supported by the practice manager and were committed to providing a quality service to their patients.
• All complaints were dealt with in an open and transparent way by the practice manager.
• The practice had a programme of regular clinical audits in place.
• Staff had been trained to handle emergencies and appropriate medicines and emergency equipment was readily available in accordance with current guidelines.

We carried out this announced inspection to follow up concerns identified in December 2013. Our concerns related to practices around decontamination of equipment not being effective in reducing the risk of cross infection to patients; recruitment practices not being sufficiently robust to protect patients from being cared for by unsuitable staff; and assessment and monitoring of potential risks was not managed effectively enough to promote patient safety.

We gave short notice of this inspection because we needed to meet the registered manager and a representative of Independent Dental Holdings (IDH). This company had taken over ownership of the practice six weeks before our inspection. Following the last inspection, we had received an action plan from the provider, which showed how they intended to become compliant. IDH had told us they carried out a thorough audit prior to taking over the practice and had an action plan, which resulted in the temporary closure of the building for two weeks for major renovations. During this time patients were offered appointments at a Barnstaple dental practice.

At this inspection, we wanted to see if patients received a safe, effective, caring, responsive and well led service. We did not speak extensively to patients using the service. We saw significant improvements in quality monitoring systems, working practices and the overall environment. We saw robust infection control, recruitment and quality systems that were effective and ensured patient safety. Patients were treated with respect in a caring way. Staff were being supported and had done training during the short closure. Overall, the actions taken since the ownership change demonstrated that the practice was well led. We were satisfied the organisation had acted in both a robust and timely way and concluded the provider was now compliant.

We carried out a routine inspection of Heddonscroft Dental Practice on 6 December 2013. We looked at four patient’s records in detail and spoke with them during and after their appointment. We spoke with another four patients over the phone about their experiences of treatment at the practice.

Patients made comments which were positive about their experiences. These included: “The receptionists are brilliant because they know patients so well”; “I was given advice about a tooth and keeping my gums healthy, which had been a problem and it’s really helped me improve my own health”.

There were some areas, which patients felt could be improved with comments such as “Sometimes it’s hard to understand what the dentist is saying, so it can come across as abrupt”; and for one person with communication difficulties their relative told us they “find it very difficult to follow what dentists are saying because they speak with a mask on”. Patients told us that the environment was “looking downtrodden and a bit shabby, in need of a lick of paint”.

Patients told us that the dental practice had discussed treatments with them, and provided an estimate of costs about the treatment available to them. For example, one person told us “It’s very good they checked everything and were very thorough in explaining. Nothing was wrong so I am pleased”.

Patients were safe and we saw that the practice followed strict procedures to protect vulnerable patients. For example, staff followed up patients to ensure they attended appointments at the local hospital or another dental practice when their care needed to be referred to a specialist.

Patients told us that there was a high turnover of dentists commenting “It would be nice to always see the same dentist for a bit of continuity” and “I’ve been using the practice for years but more recently seen different dentists each time because they’ve left”. Patients felt the dental staff “did a very good job” and were “apologetic” if a patient had to return to see them after treatment. Overall, patients told us they were “satisfied” and “generally happy with the service”.

We looked at seven outcomes and found the provider was non-compliant in three areas. These related to practices around decontamination of equipment not being effective in reducing the risk of cross infection to patients; recruitment practices not being sufficiently robust to protect patients from being cared for by unsuitable staff; and assessment and monitoring of potential risks was not managed effectively enough.