We carried out an announced comprehensive inspection on 21 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

West Street Dental Practice is a general dental practice in the centre of Leighton Buzzard, Bedfordshire.

The practice has eight treatment rooms and offers NHS treatment to adults and children. Certain treatment options are available funded privately.

The practice has undergone recent expansion and has doubled in size in the last year.

The practice now has two principal dentists, five associate dentists and two foundation dentists. This means that the dentist recently qualified and is undertaking a year of mentored working where they receive support from their in practice trainers as well as attending training days. Both the principal dentists acted as trainers for the foundation dentists.

The practice employs four dental hygienists, eight qualified dental nurses and four receptionists.

The practice is open from 8.30 am to 7.30 pm on Monday, Tuesday, Wednesday and Thursday. 8.30 am to 5.30 pm on a Friday and 9 am to 1 pm on a Saturday.

The practice is fully accessible to wheelchair users; with a disabled parking space, ramp to the front door, ground floor treatment rooms and an accessible toilet.

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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience. We received feedback from 33 patients. These provided a positive view of the services the practice provides. Patients commented on the quality of care, the polite and friendly nature of staff and the cleanliness of the practice.

Our key findings were:

• The practice was visibly clean and clutter free.

• Comments from patients indicated that the staff were kind and caring and were skilled at putting nervous patients at ease.

• The practice met the standards set out in national guidance regarding infection control.

• A routine appointment could be secured within a couple of weeks and emergency appointments would be arranged on the day they contacted the service.

• The practice had policies in place to assist in the smooth running of the service.

• The practice had medicines and equipment to treat medical emergencies.

• Dentists at the practice used national guidance and standards in the care and treatment of patients.

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.

• Governance arrangements were in place for the smooth running of the service.

• Appropriate pre-employment checks were being carried out to ensure the service employed fit and proper persons.

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

• Review the practice protocols regarding records of prescription forms with reference to the NHS guidance on security of prescription forms August 2013.

During our inspection of West Street Dental Practice on 20 June 2013, we found that some systems and record keeping designed to monitor and reduce the risk of a contaminated water supply (including Legionella) were lacking. We judged this to have a minor impact on people using the service.

When we inspected the service again on 21 October 2013, we found that dental unit water lines were flushed several times each day with antimicrobial solution and staff maintained accurate records to demonstrate this. We also found that hot and cold water temperature checks were taken from every water outlet at the service on a monthly basis. Well completed log sheets were available to demonstrate this. All of the staff we spoke with were knowledgeable about and adhering to the infection control measures and associated record keeping.

This meant the service now had appropriate systems and record keeping in place designed to monitor and reduce the risk of a contaminated water supply (including Legionella).

During our visit to West Street Dental Practice on 20 June 2013, the people we spoke with said they received very good explanations and advice about their care from the dentists. They told us they felt very involved in the discussions around their dental care. People said they felt the surgery was very modern and clean. They said they felt the dental staff team were professional and knowledgeable and they had never needed to complain about the service. One person said: "My experience here has been fine. I'm very happy with the service." Another person said: "I've been impressed with both the dentists I've seen here."

During our visit we found each person's chronology of treatment and any relevant discussions had with them to be well documented. We found that each person had their medical history and any risk factors specific to them reviewed and recorded. We saw that arrangements were in place to deal with foreseeable emergencies, including the provision of items for use in an emergency. We found that staff were appropriately qualified and registered and receiving professional development relevant to their roles. We saw the environment was clean. However, some processes designed to prevent the risk of infection were lacking or did not meet specification.

We found the service had a complaints system in place and people had their complaints responded to appropriately. Information about the complaints procedure was readily available to people who use the service.