We carried out this announced inspection on 4 December 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.

Background

15, The Pantiles Dental Practice is in Billericay, Essex and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available near the practice.

The dental team includes two dentists, one visiting implantologist, one hygienist, four dental nurses, one receptionist and one practice manager. The practice has three 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 49 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two dental nurses, one dental hygienist and the practice manager. 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 8am to 5.30pm.

Wednesday from 8am to 5.30pm.

Thursday from 10am to 7pm.

Friday from 9am to 5pm.

Saturday (the first two of each month) from 9am to 1pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. There was no thermometer available to test water temperatures when cleaning instruments.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of a paediatric ambubag. Fridge temperatures were not monitored. Following the inspection, the provider took immediate action to replace equipment and put systems in place to monitor fridge temperatures.
• The practice had effective systems to help ensure patient safety. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control.
• Not all the clinicians were using rubber dam to protect patients’ airways.
• The practice had some systems to help them manage risk. There was scope to ensure risk assessments were in place when undertaking domiciliary visits and when the hygienist worked without chairside support.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• 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 provided evening appointments on Thursday to 7pm and morning appointments on Tuesday and Wednesday from 8am. Appointments were available on the first and second Saturday of each month from 9am to 1pm.
• 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. We noted that feedback from patients and other external surveys had been wholly positive.
• 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 practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”. In particular review the risks associated with the transport of contaminated instruments outside the practice's premises, the availability of medical emergency equipment for domiciliary visits and the necessity of a second oxygen cylinder where appropriate for the practice's circumstances.
• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.
• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.
• Review the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular ensure the areas identified in the 2016 electrical fixed wiring report are completed.