We carried out an announced comprehensive inspection on 24 January 2017 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 Dental Care Paignton is located in the coastal town of Paignton, Devon. The practice provides primary dental care services. The practice provides NHS care. There are three dental surgeries (one situated on the ground floor and two on the first floor). There is level access from the street. Approximately 4,000 patients are registered at the practice.

The staff structure of the practice consists of two permanent dentists and a locum dentist. The practice is seeking to appoint an additional third full-time permanent dentist. There is a practice manager, one qualified dental nurse and three trainee dental nurses registered on a training course to achieve their dental nursing qualification. The practice also employs a receptionist and a cleaner.

The practice is open from Monday to Friday from 8.30am to 5.00pm. There is an answer phone message directing patients to emergency contact numbers when the practice is closed.

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 manager is also the registered manager at a separately registered dental practice approximately one mile away from Smile Dental Care Paignton.

The inspection took place over one day and was carried out by a CQC inspector and a dentist specialist advisor.

Nine patients provided feedback directly to CQC about the service. All were positive about the care they received from the practice. They were complimentary about the friendly, professional and caring attitude of the dental staff and the dental treatment they had received.

Our key findings were:

• Patients’ needs were assessed and care was planned in line with current guidance such as from the National Institute for Health and Care Excellence (NICE).
• There were systems in place to reduce and minimise the risk and spread of infection.
• There was a lead staff member for safeguarding patients. All staff understood their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Equipment, such as the air compressor, autoclave (steriliser), fire extinguishers, and X-ray equipment had all been checked for effectiveness and had been regularly serviced.
• Patients indicated that they felt they were listened to and that they received good care from the practice team.
• The practice had implemented clear procedures for managing comments, concerns or complaints.
• Patients could access treatment and urgent and emergency care when required.
• Patients could book appointments up to 12 months in advance.
• Appointment text/phone reminders were available on request 48 hours prior to appointments.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.
• Staff reported incidents and kept records of these which the practice used for shared learning.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Staff received training appropriate to their roles and were supported in their continued professional development by the management team.
• Staff we spoke with felt supported by the management team and were committed to providing a quality service to their patients.
• Staff at the practice took safeguarding concerns seriously. The dentist on duty and practice manager were able to describe scenarios where they had raised concerns about the welfare and safety of patients to the relevant authorities for advice and in order to keep patients safe. This included the referring dentist attending multi-disciplinary team meetings with other healthcare professionals to share information and devise an agency wide action plan to support vulnerable patients.

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

• Carry out a premises risk assessment for legionella.
• Design, implement and review a system for a stock rotation system to ensure items remain within date.
• Provide locum staff with all relevant induction information.
• Design, implement and review a system to ensure the correct mounting of radiographs.
• Secure the premises to the rear of the practice and install adequate housing for the compressor and suction.

We carried out this inspection as a follow up to our inspection of 29 July 2014. During the inspection on 29 July 2014 we had concerns with the infection controls at the practice.

During our previous inspection there was a small tear in one of the dentist's treatment chairs. The decontamination room where dental instruments were cleaned and sterilised had a cracked and dented work surface. Cleaning schedules were not in place. External clinical waste storage was insecure. These issues posed an infection control risk to patients.

On our follow up inspection on 26 March 2015 we spoke with two patients, both of whom told us they were pleased with the high standards of cleanliness at the practice. We also spoke with five staff including two dentists, a dental nurse, the practice manager and the operations manager.

At our follow up inspection on 26 March 2015 we found that improvements had been made in all of the required areas. Full details are contained in this report.

We spoke with four patients at the practice. We also spoke with the dentists, dental nurses, administrative staff, the practice manager and a member of the provider’s senior management team. We observed a patient’s experience during a treatment.

The practice had level access at the ground floor entrance. The practice had a toilet with disabled access. One of the treatment rooms was on the ground floor which meant people with limited mobility were able to access the service. The practice had a large waiting room with current magazines and a television available for patients. The waiting room was next to the reception area. The practice had four treatment rooms set over two floors.

We spoke with four patients during this visit who were attending for examination or treatment. The feedback was positive. One patient said "The dentist and staff are really nice and very patient with children". Another patient said “The dentist is polite and always explains all the options to me”.

The practice had a website providing information about opening hours, making appointments, emergency contacts and the options available to patients. This information was also available in the surgery and in a patient information file in the waiting room.

There was a small tear in one of the dentist’s treatment chairs. The decontamination room where dental instruments are cleaned and sterilised had a cracked and dented work surface. Both these issues posed an infection control risk to patients.