We carried out an announced comprehensive inspection on 9 February 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

Toft Road Dental Practice is located close to the centre of Knutsford. The practice has a reception and waiting room, three treatment rooms, a decontamination room and patient toilet facilities on the ground floor, and a treatment room on the lower ground floor. Parking is available outside the practice in a private car park. The practice is accessible to patients with disabilities, limited mobility, and to wheelchair users.

There are steps at the front entrance to the practice with handrails positioned alongside to assist patients with limited mobility. The provider has a portable ramp available to facilitate access to the practice for wheelchair users.

The practice provides general dental treatment to patients on an NHS or privately funded basis. The opening times are Monday 8.45am to 4.45pm, Tuesday to Thursday 8.45am to 5.30pm, and Friday 8.45am to 4.30pm. The practice is staffed by two principal dentists, an associate dentist, a dental therapist and seven dental nurses.

One of the principal dentists 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.

We received feedback from 46 people during the inspection about the services provided. Patients commented that they found the practice excellent, and that staff were professional, friendly, and caring. They said they were always given good explanations about dental treatment, and that the dentists were professional and kind, listened to them and delivered treatment of the highest quality. Patients commented that the practice was clean and comfortable.

Our key findings were:

• The practice had procedures in place to record, analyse and learn from significant events and incidents.
• Staff had received safeguarding training, and knew the processes to follow to raise concerns.
• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
• The premises and equipment were clean and secure.
• Staff followed current infection control guidelines for decontaminating and sterilising instruments.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current standards and guidance.
• Patients received information about their care, proposed treatment, costs, benefits, and risks and were involved in making decisions about it.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• Patients were treated with kindness, dignity, and respect, and their confidentiality was maintained.
• Emergency appointments were available.
• Services were planned and delivered to meet the needs of patients.
• The practice gathered the views of patients and took their views into account.
• Staff were supervised, felt involved, and worked as a team.
• Governance arrangements were in place for the smooth running of the practice, and for the delivery of high quality person centred care.
• Staff had been trained to deal with medical emergencies, and emergency medicines and equipment were available, but one emergency medicine was not suitably stored.
• There was evidence of deterioration in the decontamination room fixtures and fittings which did not support good infection control.

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

• Review the storage of refrigerated medicines to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored.
• Review the storage of records related to people employed to ensure they are stored securely.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities, specifically in relation to fire safety.
• Review the practice’s infection control procedures and protocols having due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the current legionella risk assessment having due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance
• Review the storage of paper dental care records to ensure they are stored securely.
• Review the practice’s complaint handling procedures and establish an effective system for recording, investigating and responding to complaints by patients.