We carried out an announced comprehensive inspection on 19 July 2016 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

Wistaria Dental Practice is located in the market town of Crediton, Devon. The practice provides Primary Dental Care services for people who require dental procedures. The practice provides private patient care. There are two dental surgeries situated on the ground floor of the premises with level access from the street. Approximately 1,500 patients are registered at the practice. The majority of patients are adults.

The staff structure of the practice consists of one dentist and two dental hygienists. There is a practice manager, two dental nurses and a trainee dental nurse. Dental nurses also act as reception staff. The practice also employs an oral health educator.

The practice is open from Monday to Thursday, with Saturday morning sessions on one day per month. Clinical sessions are not available on Fridays; however the practice reception opens between 9am to 12pm on Fridays. There is an answerphone message directing patients to emergency contact numbers when the practice is closed.

The owner and dentist 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 inspection took place over one day and was carried out by a CQC inspector who had access to remote advice from a specialist advisor.

Thirty patients provided feedback directly to CQC about the service. Twenty nine patients 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. Negative feedback was received from an anonymous source. We looked into these concerns raised regarding cleanliness and staff attitudes and found the concerns were unsubstantiated.

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 effective 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.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• 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.
• Patients benefitted from access to an oral health educator on the premises.
• The provider had a clear vision for the practice and staff told us they were well supported by the management team.

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

• Review at appropriate intervals the training, learning and development needs of individual staff members and have an effective process established for the on-going assessment of all staff.
• Review the practice's recruitment policy and procedures to ensure character references for new staff are requested and recorded suitably.
• Review the governance processes for formally recording and communicating outcomes from internal staff meetings effectively.
• Develop systems to publicise the action taken by the practice as a result of patient feedback.

Wistaria Dental Practice is a small dental service, serving people from mid-Devon as well as people who made annual visits from as far away as France and America. We met and spoke with four patients during our inspection and looked at the records of eight patients. We spoke with all of the staff working in the practice during our inspection including the registered manager and dentist, the dental nurses and the practice manager.

From information displayed we saw the practice had been providing services for twenty years. A framed newspaper article and “congratulations” cards showed patients were very satisfied with the quality of services provided. Comments included; “Thank you for all your years of excellent service”; “Congratulations and thanks for all your care”; and “Thank you for all your kindness and everything you have done for me”. Comments from the patients we spoke with included; “I wouldn’t go anywhere else but here”; and “The staff are fantastic, friendly and treat me as part of the family”.

Information about the practice and the services it offered was provided in a variety of formats including a range of practice leaflets and information sheets; information leaflets from health and associated providers about dental care and oral health as well as information on the providers’ website. Patients told us they felt informed and were involved in decisions about their care and treatment; they knew how much treatment would cost and what would happen after their appointments.

Care and treatment was provided in line with national guidance and we saw the provider worked to the standards expected from the General Dental Council (GDC). Cleanliness and infection control was maintained to the standards outlined in the Department of Healths guidance document HTM 01-05 2013 and was provided by staff who went through appropriate recruitment processes. All qualified staff were registered with the GDC.

Records relating to patient care and treatment were routinely completed and showed the patients care pathway. We saw evidence of signed treatment plans as well as completed medical and medication forms. Records relating to the management of the practice were appropriately maintained and stored securely.