We carried out this announced inspection on 11 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 CQC registration inspector and 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

Alexandra Dental Practice is based in Reading and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs via a portable ramp.

The dental team includes four dentists, five dental nurses, one trainee dental nurse, three dental hygienists, three receptionists and a practice manager. The practice has six treatment rooms of which five are in use.

The practice had recently been joined by a second practice following extensive renovation work to the first floor of the building. We did not inspect this second practice on the day of our inspection.

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 Alexandra Dental Practice is the practice manager.

On the day of our inspection we collected 19 CQC comment cards filled in by patients and obtained the views of five other patients.

During the inspection we spoke with two dentists, three dental nurses, one receptionist and the practice manager. Two support staff from head office were also in attendance at the inspection.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday 7.00am to 5.00pm
• Tuesday 7.00am to 5.00pm
• Wednesday 8.00am to 5.00pm
• Thursday 7.00am to 5.00pm
• Friday 7.00pm to 2.00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control decontamination procedures which reflected published guidance but improvements were needed.
• Staff knew how to deal with medical emergencies
• The practice had systems to help them manage risk but did not operate these effectively.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children but training required improvement.
• Improvements were needed to staff recruitment procedures.
• The practice did not ask for patient feedback about the services they provided.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The management of staff training was not effective.
• Staff felt involved, supported and worked well as a team.
• The management of significant event and complaints was not effective.
• The practice had suitable information governance arrangements.
• The practice did not have effective clinical and management leadership or a culture of continuous improvement.
• We have been provided evidence to confirm all but one of the shortfalls identified have been addressed. The area outstanding is effective staff recruitment processes.

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

• Review the practice's recruitment procedures to ensure appropriate checks are completed prior to new staff commencing employment at the practice.