We carried out this announced inspection on 12 November 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

AJB Denture Services Ltd is in Billericay, Essex and provides private treatment to adults.

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

The dental team includes three visiting associate dentists with the following specialisms; two oral surgeons, one dentist with a special interest in periodontology, one dentist with a special interest in implants and one in general dentistry. They are supported by three dental nurses, three receptionists, one administrator, the provider (a dental technician), the clinical manager and a visiting quality assurance compliance coordinator. A visiting sedationist attends the practice to oversee sedation on request. We were told this was between three to four times per year. Upstairs there is a dental laboratory where dentures and implant teeth are made and downstairs the practice has two treatment rooms.

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 AJB Denture Services Ltd was the provider.

On the day of inspection, we collected 13 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, one dental nurse, one receptionist, the provider, the quality assurance compliance coordinator and the clinical manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 8.30am to 5.30pm.

Our key findings were:

• The practice appeared mostly clean and well maintained. We noted water damage to two ceiling tiles in the second treatment room. We saw that these were replaced following the inspection.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• 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 appointment system met patients’ needs.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• Not all the dentists had undertaken operator training for the cone beam computed tomography (CBCT) machine. Following the inspection, the practice confirmed this had been scheduled for all dentists.
• 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.
• The practice staff dealt with complaints positively and efficiently. There was scope to include a wider range of incidents and complaints as significant events to ensure any training needs were identified and to prevent such occurrences happening again in the future.
• The practice staff had suitable information governance arrangements.

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

• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account HPA-CRCE-010 Guidance on the Safe Use of Dental Cone Beam (Computed Tomography).
• Review staff training to ensure that dental nursing staff who assist in conscious sedation have the appropriate training and skills to carry out the role, taking into account 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'.