We carried out this announced inspection on 15 April 2019 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

518 Dental is in Rochdale and provides NHS treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice on local side streets.

The dental team includes four dentists (two of whom are principals) and seven dental nurses (two of whom dual role as the practice manager and receptionist), the remaining five dental nurses are trainees. The practice has four treatment rooms.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at 518 Dental is one of the principal dentists.

On the day of inspection, we collected 34 CQC comment cards filled in by patients. All comments reflected positively on the service.

During the inspection we spoke with four dentists and four dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday 9am to 5:30pm and Friday 8am to 3pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures. Improvements could be made to the process to ensure they fully reflect published guidance.
• Staff knew how to deal with emergencies. Improvements could be made to ensure all appropriate medicines and life-saving equipment was available in line with guidance.
• The practice had systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and a culture of continuous improvement. Improvements could be made to ensure audits were completed effectively and learning outcomes were documented.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

During the inspection we identified an area of notable practice in respect to their responsiveness to the needs of different people including those in vulnerable circumstances. We saw evidence of team involvement in practice and within the wider community. The practice was involved in the following in-house and external initiatives with the aim of promoting oral health and helping to improve care. In particular: Healthy Living dentistry and Baby Teeth Do Matter which are part of the Greater Manchester Combined Authority initiative, Rochdale connecting You, Homeless Alliance Response Team (HART) and links to Dental Public Health.

There were areas where the provider could make improvements. They should:

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular: Use of personal protective equipment (PPE), instrument cleaning and water temperature monitoring.
• Review the availability of equipment and medicines in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council and the British National Formulary.
• Review the practice’s protocols to ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.