We carried out this announced inspection on 9 May 2017 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 two specialist dental advisers.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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

Mydentist, North Street, Exeter is in the city of Exeter and provides NHS and private treatment to patients of all ages.

The practice is situated on the first floor, with no lift access. There is city centre car parking nearby.

The dental team includes six dentists, five dental nurses, one trainee dental nurse, three receptionists and a practice manager. The practice has six treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at Mydentist, North Street, Exeter was the practice manager.

On the day of inspection we collected 15 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open: Monday 8.30am – 7.30pm. Tuesday 8am – 7.30pm. Wednesday 8am – 5pm. Thursday 8am – 7.30pm. Friday 8am – 5.30pm.

Our key findings were:

• The practice was a ‘prototype’ practice. This is a new type of NHS contract using a preventive care pathway intended to provide individualised patient oral health assessment and advice.
• The practice had infection control procedures which reflected published guidance. There were plans in place to improve facilities at the practice with the addition of a dedicated dental instrument decontamination room.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice 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.
• The appointment system met patients’ needs.
• The practice had effective leadership. 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 dealt with complaints positively and efficiently.

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

• Review the practice’s current systems in place for environmental cleaning taking into account current national guidelines.
• Review arrangements to ensure that patient data and information are protected adequately when treatment rooms are unoccupied.

There were six dentists working at Pittar Chambers Dental Centre at the time of our inspection and a further dentist about to fill the only vacancy. We spoke with the practice manager, two dentists, receptionists and two dental nurses including the lead nurse for infection control. We also spoke with six people on the telephone who had been asked for permission by the surgery to speak with us about their experiences.

One person told us they found the dentists "lovely, calming and that the visits are actually quite relaxing". People told us that the dentists gave them good information and they got appointments on dates of their choice including emergency appointments. One person said, "The dentists have been very good, thorough and friendly. I’ve never had to complain and I’ve been going there for a long time." Another person said, "They are friendly, I can’t fault them at all”.

We saw that new patients were asked for their medical history, so that the dentist would know of any necessary precautions and that dentists gave good explanations about treatment.

The older style premises were not purpose built and had no disabled access due to narrow stairs but the waiting area was spacious, so that people could maintain their privacy when talking to staff. However, the dental surgery did not have robust processes in place for the control of infection and to maintain hygiene such as safe clinical waste storage.