We carried out this announced/unannounced inspection on 25th May 2017 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 provide any information.

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

City Bridge Dental Care is in Westbury on Trym, Bristol, and provides private treatment to patients of all ages and NHS treatment to children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including one for patients with disabled badges, are available near the practice.

The dental team includes two dentists, two dental nurses, two dental hygienists, one dental hygienist therapist and two receptionists. The practice has four treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. There was a vacancy for a practice manager and a consultant practice manager was assisting the principle dentist to manage the practice on a part time basis.

On the day of inspection we collected 17 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses, one dental hygiene therapist, one dental hygienist, two receptionists and a consultant practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 08:45 to 17:45

Tuesday 08:30 to 19:00

Wednesday 08:30 to 18:00

Thursday 08:30 to 17:30

Friday 08:00 to 13:00

Out of hours there is a rota system where dentists from local practices take turn to be on call and respond to emergencies.

Our key findings were:

• The practice was clean and well maintained.
• The practice 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 had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures but references were not always obtained.
• 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 had effective leadership. 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 dealt with complaints positively and efficiently.

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

Review the practice’s system for documentation of actions taken, and learning shared, in response to accidents and incidents with a view to preventing further occurrences and ensuring that improvements are made as a result.

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

Review the availablity of a loop system to assist people with a hearing impairment to communicate with staff.

Review the practice’s audit protocols to ensure audits of conscious sedation are undertaken at regular intervals in line with current guidance to help improve the quality of service. The practice should also ensure, that where appropriate these audits have documented learning points and the resulting improvements can be demonstrated.

We spoke with six people on the day of our visit and all of them reported that they were happy with the service provided at City Bridge Dental Practice. We were told that treatments were well explained and the costs involved were made clear. People said that they had time to ask questions during their appointment and weren't rushed. One person told us that they were a nervous patient and because of this, the practice had been recommended to them.

People using the service were treated by staff who were supported in their continuing professional development and were trained to manage medical emergencies. Staff were also aware of their responsibilities to safeguard children and vulnerable adults and there were policies and procedures in place to support them in this.

Procedures for the decontamination of instruments met with the requirements of the Health Technical Memorandum HTM 01-05. This is the guidance that all dentists must follow to ensure that their practice is safe and minimises the risk of cross infection.