When we visited the practice on 7 May 2014, we found patients were not fully protected from the risk of infection because appropriate guidance had not always been followed. We set a compliance action in respect of this. We received an action plan which set out what actions were to be taken, to achieve compliance.

During this inspection we found the practice had taken effective action and achieved compliance.

During the visit we toured the practice and found the surgeries were clean and tidy. The infection control policy was now kept behind the reception area in a folder, and this was accessible to all staff members. The practice manager had devised checklist infection control protocols and these were displayed in treatment rooms. We found the procedures were in date and reflected current professional guidance.

A staff member demonstrated the process for cleaning dental equipment in the decontamination room. We saw during the process the staff member wore appropriate personal protective clothing at all stages of the process. We saw the personal protective equipment (PPE) was disposed of appropriately.

We undertook a follow up inspection of this service to review the areas of concern identified in September 2013. We did not speak with patients during our visit as it was not appropriate to do so.

During this inspection we found the provider had appointed an infection control lead and put in place an action plan to address the findings from the previous inspection. We saw a new infection control policy had been written and reviewed, equipment had been repaired or replaced, clinical waste was being disposed of safely and the water quality had been assessed. In addition audits of infection control and hand washing had been implemented.

Despite the improvements we identified further concerns in relation to the control and risk of infection. For example, we observed the incorrect disposal of used personal protective equipment (PPE). There were areas of one surgery with dust behind boxes and staining on the cabinets and the floor in one surgery was damaged.

The provider had put in place a comprehensive schedule of audits to support them to identify and assess risks to the health, safety and welfare of patients who used the services. In addition audits to assess the quality of clinical work had been implemented. As a result of audits the practice had been responsive and had implemented actions to improve for example the quality of x-rays and hand washing. The provider had made significant improvement in this area of quality assurance.

During our visit to Peachcroft Dental Practice we met with the registered manager. We spoke with four members of staff. We spoke with seven patients and looked at seven patient records.

All of the patients we spoke with were very happy with the dental treatment they received. One patient told us “everyone is so nice and friendly and helpful here”. Another patient said “he [the dentist] gave me the options, we discussed it”. We looked at patient records which confirmed the treatment patients said they had received.

Staff told us they were supported to carry out their roles. We saw that staff received training specific to their job. We saw that staff received an annual appraisal.

The practice did not operate processes, and followed procedures, that minimised the risk and spread of infection because current guidelines had not been followed.

The practice had systems in place to seek and act on patient feedback and respond to patient complaints. However the practice did operate systems to regularly assess the quality of clinical work and records. The practice also did not effectively operate systems to identify, assess and manage risks relating to the health and safety of patients.

We carried out an announced comprehensive inspection on 14 April 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

Peachcroft Dental Practice is a dental practice providing NHS and private treatment for both adults and children. The practice is situated in Abingdon, a town south of Oxford.

The practice has four dental treatment rooms and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The practice is based on the first floor of a retail shopping centre.

The practice employs four dentists, a hygienist, five dental nurses of whom three are trainees, two reception staff and a practice manager.The practice’s opening hours are 9am to 1pm and 2pm to 5pm Monday to Friday. There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service. The practice has opted out of providing out-of-hours services to their own patients and refers them to South Central Ambulance Service via the NHS 111 service.

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.

During our inspection we reviewed 26 CQC comment cards completed by patients and obtained the view of 11 patients on the day of our inspection.

The inspection was carried out by a CQC specialist dental inspector.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.

• Strong and effective leadership was provided by an empowered practice manager.

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.

• The practice appeared clean and well maintained.

• Infection control procedures were robust and the practice followed published guidance.

• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.

• Staff reported incidents and kept records of these which the practice used for shared learning.

• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.

• The service was aware of the needs of the local population and took these into account in how the practice was run.

• Patients could access treatment and urgent and emergency care when required.

• Staff recruitment files were organised and complete.

• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD) by the practice manager.

• Staff we spoke with felt well supported by the practice manager and were committed to providing a quality service to their patients.

• Information from 26 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high 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:

• Introduce a system for capturing national safety alerts such as those issued by the Medicines and Healthcare products Regulatory Agency (MHRA).

• Consider collating all documents pertaining to dental radiography into one file.