We carried out an announced comprehensive inspection on 30 November 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

Smile Concepts provides general and specialist dental services on a private basis. The service is provided by nine dentists (three of whom are specialists) and two dental hygienists. The three specialist dentists have a range of specialities amongst them including oral surgery, periodontics and restorative dentistry. They are supported by a practice manager, a receptionist, a decontamination assistant and six dental nurses (one of whom is a trainee). A chiropodist is also employed by the practice. A consultant anaesthetist visits the practice on an ad hoc basis to provide conscious sedation for nervous patients (approximately every six weeks). (Conscious sedation involves techniques in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation).

The practice is located on a main road in a residential area. There is a designated car parking bay and access to the premises for patients with disabilities. There is a reception area, waiting area, two treatment rooms and accessible toilet facilities on the ground floor to accommodate patients who cannot use the stairs. There are a further three treatment rooms, a CT scanner, a decontamination room, toilet facilities and a room for the chiropodist on the first floor. The practice is also involved in dental postgraduate training so there are training rooms available on the first floor. Opening hours are Monday, Tuesday, Wednesday, Thursday and Saturday 8:30am to 5:30pm and Friday 8am to 3:30pm.

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.

25 patients provided feedback about the practice. We looked at CQC comment cards patients had completed prior to the inspection and we also spoke with patients on the day of our visit. Patients were positive about their experience and they commented that they were treated in a respectful and professional manner. Patients felt that the staff were friendly, caring and informative.

Our key findings were:

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained. They had access to an automated external defibrillator (AED). An AED is a portable electronic device that analyses life threatening irregularities of the heart including ventricular fibrillation and is able to deliver an electrical shock to attempt to restore a normal heart rhythm.
• The practice had systems to assess and manage risks to patients, including infection prevention and control, health and safety, safeguarding and the management of medical emergencies.
• Patients told us they were treated with respect and dignity by staff. Patients commented they felt involved in their treatment and that it was fully explained to them.
• Patients were able to make routine and emergency appointments when needed.
• The practice had an effective complaints system in place and there was an openness and transparency in how these were dealt with.
• Governance arrangements were in place for the smooth running of the practice.

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

• Review infection control guidance for Legionella prevention and the designation of clean and dirty zones in clinical areas. (Legionella is a term for particular bacteria which can contaminate water systems in buildings).

• Review the practice's recruitment policy and procedures to ensure character references for new staff as well as qualification certificates are requested and recorded suitably. Employees should subsequently have regular appraisals to formally discuss their mandatory training, learning needs and aspirations.
• Adopt a system to monitor and maintain fridge temperature.