We carried out an unannounced comprehensive inspection on 10 October 2016 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 is located on two floors of premises situated in the Normanton area of Derby to the south of the city centre. The practice provides mostly NHS dental treatments (90%). There is a pay and display car park approximately 200 yards from the practice. There are eight treatment rooms one of which is located on the ground floor.

The practice provides regulated dental services to both adults and children. Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatment.

The practice’s opening hours are – Monday to Saturday: 9 am to 6 pm.

Access for urgent treatment outside of opening hours is by telephoning the NHS 111 telephone number.

The practice manager is 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 practice is registered with the Care Quality Commission (CQC) as a partnership.

The practice has seven dentists; three qualified dental nurses; four trainee nurses; and two receptionists. Some dental nurses also worked on the reception desk.

We received feedback from 29 patients about the services provided. This was by speaking with patients and through comment cards left at the practice during the inspection.

Our key findings were:

• The premises were visibly clean and there were systems and processes in place to maintain the cleanliness.
• Staff were not able to demonstrate they had learnt from accidents and significant events to reduce the likelihood of them being repeated.
• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
• The radiation protection file did not contain all of the information that it should.
• Patients said they had no problem getting an appointment that suited their needs.
• Patients were able to access emergency treatment when they were in pain.
• Patients provided positive feedback about their experiences at the practice. Patients said they were treated with dignity and respect; and the dentist involved them in discussions about treatment options and answered questions.
• Patients’ confidentiality was protected.
• The records showed that apologies had been given for any concerns or upset that patients had experienced at the practice.
• The practice followed the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
• The management of waste at the practice had not been monitored and evaluated.
• There was a whistleblowing policy accessible to all staff, who were aware of procedures to follow if they had any concerns.
• The practice had the necessary equipment for staff to deal with medical emergencies, and staff had been trained how to use that equipment. This included an automated external defibrillator, oxygen and emergency medicines.

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

• Review the systems and processes for identifying, managing and monitoring risk; for example significant event management, infection control procedures, record-keeping.

• Review how consent is recorded within patient dental care records to ensure that the discussion outlining options and likely consequences are recorded.

As part of this inspection we spoke with five people who used the service and six members of staff including two dentists.

We saw that consent had been obtained and that treatment plans were completed. People we spoke with felt that procedures were explained and that they were able to ask questions.

All the people we spoke with were happy with the care and service provided by the provider. One person who used the service told us “I would recommend folks to come here”; another stated “They are great”.

There were effective systems in place to reduce the risk and spread of infection and staff understood the importance of these.

We found that the provider had not carried out full pre-employment checks on all staff members to ensure that they were suitable to work in this environment.

The provider had a clear complaints policy in place.