We carried out this announced inspection on 6 June 2018 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.

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Background

St Kilda's Dental Practice is in Tring, Hertfordshire and provides NHS and private treatment to patients of all ages.

The practice has steps to the entrance and is therefore not suitable for people who use wheelchairs. Internally the practice has a stair lift to assist patients’ access to the first floor. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes five dentists, three dental nurses, a dental hygienist and three receptionists. The practice has two 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 43 CQC comment cards filled in by patients.

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

The practice is open:

Monday from 9am to 5pm.

Tuesday from 9am to 8.15pm

Wednesday from 9 am to 8.30 pm

Thursday from 9am to 5pm

Friday from 9am to 5pm

Saturday twice a month from 9am to 1pm.

The practice is closed between 1pm and 2pm daily.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• 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 staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.

• Review the practice’s protocols for audits to ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. For example in relation to fixed wire checks and logging fire checks.

During our inspection of St Kilda’s Dental Practice on 21 November 2013, we observed that people were treated politely and with respect. It was evident from the written records that the dentist involved people in their treatment plan. One person commented, “This is one of the best dentists I have had, and I am prepared to travel to come here.”

People completed medical questionnaires at the start of each treatment. We saw these were kept in their records to ensure the dentist was able to provide treatment that was planned and delivered to suit their needs and conditions. People told us they felt confident the dentists were well qualified and told us they were always seen when they needed an appointment.

All areas of the practice were clean and tidy and there were robust infection control processes in place to ensure people were treated safely. One person said, “It’s very clean here.”

Information was made available to people who used the service, which explained what they could expect as a patient. There was clear guidance for people should they need to make a complaint. People told us that they would be confident to make a complaint if it was necessary and we saw that people were given the appropriate information to do so. One person said, “I have no complaints, but I would say something if I was not happy.”