We carried out this announced inspection on 22 August 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 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

S R Williams Limited is more commonly known as Symonds Yat Dental Surgery and is located in the rural village of Symonds Yat West between Monmouth and Ross-on-Wye in Herefordshire. The surgery provides predominantly NHS treatments with some private upgrades to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. The ground floor of the practice consists of a reception area, a waiting room, two patient toilets, three dental treatment rooms and an x-ray room. On the first floor there is a staff room / kitchen, staff toilet and changing facilities, a practice management office and a decontamination room for the cleaning, sterilising and packing of dental instruments. Car parking spaces, including one for patients with disabled badges, are available directly outside the practice in their dedicated car park.

The dental team includes three dentists, five dental nurses, two trainee dental nurses, two dental hygienists, three receptionists and a practice manager who is also a qualified dental hygienist. The practice has three 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 collected one CQC comment card filled in by a patient and spoke with six other patients. This information gave us a positive view of the practice.

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

The practice is open:

Monday to Friday: 8.15am – 5pm

Our key findings were:

• The practice was clean and well maintained. Two contracted cleaners were responsible for the day to day cleaning.
• The practice had infection control procedures which reflected published guidance with the exception of the infection control audit which had lapsed.
• 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 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 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. Patient feedback surveys; and friends and family test cards were available for patients to complete in the waiting room.
• The practice dealt with complaints positively and efficiently.

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

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the staff supervision protocols and ensure an effective process is established for the on-going appraisal of all staff.
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as infection prevention and control are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

We spoke with eight adults and two children during the inspection. The children, their parent and four other people agreed to us being in the surgery during their appointments. People were pleased with the service they received. One of the people we met told us that the dental team were, “very careful” regarding their specific needs. Another described themselves as, “fortunate” in their choice of dentist.

We observed that the dentists explained carefully what they were doing. People told us this always happened. The dentist spoke with the children in a reassuring way without speaking down to them. One of them told us, “I like the lady who does my teeth”.

There was medication and oxygen available for certain medical emergencies and staff were trained to know what to do if a person became unwell at the practice.

The practice was clean and people we spoke with told us they thought standards of cleanliness were very good. There were suitable arrangements for the cleaning, sterilising and storing of instruments. Staff described these procedures to us confidently.

The dental team were qualified and maintained their continuous professional development (CPD) as required by the General Dental Council (GDC). The practice manager monitored this and we saw that there were staff files for each member of the team.

The practice had arrangements for monitoring the quality of the service and for assessing and reducing any risks to people using the service, or staff.