We carried out this announced inspection on 30 January 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not have any relevant information to share with us regarding this dental practice.

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

Alexandra Dental Care is situated in Swadlincote in south Derbyshire. The practice provides mainly private dental treatment and NHS dental treatment mostly to children.

The practice has five treatment rooms, three of which are located on the first floor. There is free car parking close to the practice.

The dental team includes: seven dentists, one foundation dentist, three dental hygienists, 13 qualified dental nurses, two trainee dental nurses and a practice manager.

The practice is a training practice with one foundation dentist working there at the time of this inspection. A foundation dentist is a newly qualified dentist gaining experience in a supported environment for the first year after qualification.

The practice is owned by an organisation 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 the practice is the principal dentist.

On the day of inspection we received feedback from 25 patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, one dental hygienist, ten dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice opening hours are: Monday: 7.45am to 8pm; Tuesday 7.45am to 6pm; Wednesday 7.45am to 6pm; Thursday 7.45am to 7pm; Friday: 7.45am to 6pm and Saturday: 9am to 1pm.

Our key findings were:

• The practice was clean and was undergoing planned refurbishment in some areas of the practice.
• The practice had infection control procedures which followed published guidance.
• The practice asked staff and patients for feedback about the services they provided, and received positive feedback.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Rectangular collimation was not being used with all X-ray machines within the practice.
• The practice had systems to help them manage risks in the practice, particularly with regard to health and safety.
• The practice had suitable safeguarding processes. Staff had been trained and 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 measures to protect their privacy and personal information.
• The practice completed regular audits and used the information to make improvements.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice did not have an induction hearing loop to assist patients who used a hearing aid.

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

• Review the protocols and procedures for use of X-ray equipment taking into account Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

As part of this inspection we spoke with five people who used the service and five members of staff including two dentists.

People we spoke with told us that they were very happy with the service and the care that was provided. People felt that they were given options about different treatments including costs and were given time to make decisions. One person described the provider as “brilliant” and another told us “they are great”.

There were effective systems in place to reduce the risk and spread of infection. Staff had an understanding of their responsibilities and the importance of infection control.

We found there were effective recruitment and selection processes in place to ensure that staff were suitable to work in this environment.

The provider had a clear complaints policy in place and there was evidence that complaints had been investigated and appropriate action taken.