We carried out this announced inspection on 20 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

Ash Villa Dental is in Sale, Manchester and provides private treatment to adults and children.

There is a ramp to access the premises for people who use wheelchairs and those with pushchairs. A small car park is provided with additional on street parking nearby.

The dental team includes three dentists comprising of the principal dentist and two associate dentists, a clinical practice manager, a business practice manager, three dental nurses, a part time dental hygiene therapist, a receptionist and a reception manager. The practice has three 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.

On the day of inspection, we collected 33 CQC comment cards filled in by patients. Patients were very positive about the service.

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

The practice is open:

Monday 9:00am - 6:00pm

Tuesday 9:00am - 7:00pm

Wednesday and Thursday 9:00am - 5:30pm

Friday 8:40am - 3:00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which should be reviewed to ensure consistency.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them identify and manage risk to patients and staff. Improvements could be made in relation to safety alerts and radiography.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures. A DBS check had not been carried out for a recently employed dentist.
• 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 provider was providing preventive care and supporting patients to ensure better oral health. Bespoke resources were used to reinforce good oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.

• 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 the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’ In particular, ensuring staff follow consistent decontamination procedures.

• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.

Patients were given appropriate information and support regarding their care or treatment. Three patients confirmed that the dentist always gave them sufficient information about their treatment options. They discussed the advantages and disadvantages of each treatment, meaning that patients could make informed decisions about which treatment would be right for them.

Patients' needs were assessed and care and treatment was planned and delivered in line with their individual treatment plan. One of the patient testimonials stated, "The care you have offered me is second to none and your dentist is quite amazing."

Patients who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider had worked continuously to maintain and improve high standards of care by creating an environment where clinical excellence could do well. Two staff confirmed they received good support from their manager and the provider to develop their knowledge, skills and professional experience.

Patients were asked for their views about their care and treatment and they were acted on. We saw that the provider took account of complaints and comments to improve the service. A patient we spoke with said, "We have been coming to this dentist for many years and he always does a great job, is always pleasant and caring. All the nurses and the rest of the team are great."