We spoke with five patients who told us they were very satisfied with the care and treatment they received. They told us the dentists explained treatments and gave plenty of good verbal and written information to support what they were doing.

We looked at records and found that they were completed accurately and were secure. We found that health assessments were undertaken and reviewed at each visit. Care and treatment plans were discussed including options, risks and benefits of treatment. Staff were trained in emergency procedures. Emergency equipment was checked and accessible. There were appropriate policies, procedures and risk assessments in place for radiological safety. We found there were sufficient numbers of suitably experienced and qualified staff in order to care for patients safely.

We found the practice was compliant with the essential quality requirements of Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05). The HTM 01-05 is designed to assist all registered primary dental care services to meet satisfactory levels of decontamination.

Staff were kept informed of changes to legislation through regular one-to-one discussions and staff meetings and their continuing professional development was monitored to ensure it was kept up to date. This meant that patients were treated by staff who were kept up to date on policies and procedures such as infection control and decontamination.

The practice carried out regular audits to ensure best practice was achieved and acted on information received from patient questionnaires and feedback from external auditors. For example funding had recently been obtained to improvements to the worktops in some of the surgeries. The service offered an 'incentive programme' to staff to increase their responsibilities and included things such as the carrying out of audits or monitoring of equipment on a regular basis.

We carried out this announced inspection on 30 November 2017 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.

We told the NHS England Cheshire and Merseyside area team that we were inspecting the practice. We did not receive any information of concern from them.

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.

Background

Woodlands Dental Practice is close to the centre of Birkenhead and provides dental care and treatment to adults and children on an NHS and privately funded basis.

The practice is located in a purpose built premises and has a ramp to facilitate access to the practice for wheelchair users. The practice has six treatment rooms. Car parking is available in the practice’s own car park adjacent to the building.

The dental team includes two principal dentists, four associate dentists, a foundation dentist, two dental hygiene therapists, 16 dental nurses, one of whom is a trainee, a sterilisation assistant and two receptionists. The team is supported by two practice managers.

The practice is owned by a company and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Woodlands Dental Practice is one of the principal dentists.

We received feedback from 29 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to five dentists, several dental nurses, receptionists, the sterilisation assistant and the practice manager. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday to Wednesday 8.30am to 5.30pm

Thursday 8.30am to 5.00pm

Friday 8.30am to 4.15pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available.
• The practice had systems in place to help them manage risk.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children. Staff had put in place additional measures to ensure vulnerable patients received the support they needed.
• The practice had staff recruitment procedures in place.
• Staff provided patients’ care and treatment in line with current guidelines.
• The practice had a procedure in place for dealing with complaints.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
• The practice had a strong leadership structure. Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided and valued their opinions.

We identified the following areas of notable practice. We believe these to be notable practice worth sharing.

The practice showed a commitment to the overall safety and wellbeing of the people who use the service which had a positive impact on patients. The practice had taken additional local measures to ensure that staff identify safeguarding issues correctly, discuss and monitor them sensitively and take action where appropriate.

• Staff maintained a log of vulnerable patients to ensure they were supported in the long term. The practice carried out regular scheduled reviews of these patients to ensure the best efforts were being made to support them and to ensure appropriate assistance was available for them should they wish it.

The practice provided training for staff in skills the provider considered necessary to meet the needs of people using the service.

• The principal dentists were committed to improving together as a practice. Training was arranged for role-specific groups of staff with the aim of providing care and treatment of a high, consistent standard across the practice.
• The practice meetings included a training section. All staff met together for the information section then broke into smaller role-specific groups for training to allow staff to learn at their own pace in an informal, more supportive environment.

The practice demonstrated a commitment to improving access to dental care and tackling oral health inequalities for people living in vulnerable circumstances.

• The principal dentist had looked at the reasons stopping people attending a dentist. Anxiety was identified as one of these. The practice put in place arrangements to help anxious patients to attend, for example, anxious patients were given a choice of the first appointment of the session so they did not have to wait in reception for a long time. They were also offered an initial appointment with one of the dental hygiene therapists to help build their confidence and support them to make an appointment with one of the dentists. Clinicians also taught patients relaxation techniques.
• The practice provided dental care to a group of refugees. Staff organised for treatment rooms to be available on certain days and arranged for interpreters to attend on those days. The refugees were welcomed to the practice as a group and as patients. They were then given the choice of being seen by the dentist on their own or accompanied by a family member or friend to discuss their individual needs and treatment.

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

• Review the availability of equipment to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK), and the General Dental Council, specifically in relation to the availability of a child sized self-inflating bag and mask.