We carried out this announced inspection on 11 October 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 not providing well-led care in accordance with the relevant regulations.

Background

Abington Dental Practice is located in Northampton, a town in the East Midlands region. It provides NHS and private treatment to adults and children. Services provided include general dentistry, implantology, adult orthodontics and sedation.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available in the practice’s car park.

The dental team includes four dentists, five dental nurses, two administrators and one receptionist. Practice administrative duties are shared between the principal dentist and the lead nurse.

The practice has three treatment rooms; two are on the ground floor.

The practice is owned by a company 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 Abington Dental Practice is the principal dentist.

The practice had plans to extend and make modifications to the existing premises. These included installing a new surgery, office and staff room as well as a new patient toilet facility suitable for those who use wheelchairs, and moving the reception area.

On the day of inspection, we collected 32 CQC comment cards filled in by patients.

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

The practice is open: Monday, Wednesday, Friday from 8am to 6pm, Tuesday and Thursday from 9am to 6pm and Saturday from 9am to 1pm.

Our key findings were:

• The practice appeared clean. We found significant improvements were required in how cleaning equipment was stored and then used within the practice.
• The provider had infection control procedures which reflected published guidance; we found areas that required review to ensure compliance with best practice.
• Staff knew how to deal with emergencies. Appropriate medicines and most life-saving equipment were available with the exception of three sizes of clear face masks and one size of oropharyngeal airways.
• The practice had some systems to help them manage risk to patients and staff. We found exceptions in relation to the management of legionella, safer sharps and risk assessments for the practice cleaner.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had incomplete staff recruitment procedures. We found that one member of staff did not have a Disclosure Barring Service (DBS) check held on their file and the practice had accepted DBS checks undertaken by staff previous employers, without completing a risk assessment.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• An external clinician visited the premises to provide sedation to patients who would benefit. We found that greater oversight was required by the provider of the current arrangements.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• Whilst some reasonable adjustments had been made to enable access for patients with limited mobility, we noted that improvements could be made for those patients with hearing impairments and those who did not speak English as a first language.
• The provider dealt with complaints positively.
• We found areas where governance arrangements required significant strengthening.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure all premises and equipment used by the service provider is fit for use.
• Maintain appropriate standards of hygiene for premises and equipment.

Full details of the regulation/s the provider was not meeting are at the end of this report.

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

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice’s protocols for conscious sedation, taking into account the guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.

Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.