We carried out this announced inspection on 18 September 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

Atlantic Dental - Newquay provides private treatment to adults and children.

There are two ground floor treatment rooms, but some steps and a not fully accessible toilet means patient using wheelchairs may need to consider alternative providers. Car parking spaces are available at the practice.

The dental team includes one dentist, two trainee dental nurses and one practice manager/receptionist. The practice has two 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 13 CQC comment cards filled in by patients. This gave us a positive view of the practice.

During the inspection we spoke with the whole staff team. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9am – 5pm. Saturdays by appointment.

Our key findings were:

• The practice appeared clean and well maintained.
• Improvements could be made regarding the availability of emergency equipment and staff training to use life-saving equipment.
• 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 practice had thorough staff recruitment procedures.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided.
• The practice had not received any complaints in the last 12 months.
• The practice staff had suitable information governance arrangements.

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

• Review the availability of equipment in the practice to manage medical emergencies and review staff training to manage medical emergencies considering the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Review the practice’s protocols to ensure audits of radiography are undertaken at regular intervals to improve the quality of the service. Where appropriate, audits should have documented learning points and the resulting improvements demonstrated.

• Review the practice’s infection protocols considering 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 with regard to flooring and air flow in the decontamination room and frequency of ultrasonic cleaner efficiency tests.

We spoke with two patients about the care they had received from Atlantic Dental. Patients fold us “actually the dentist is really good” and “I’m very happy with the service here”. Staff that we spoke with said there had been “huge improvements” since the last inspection, that things were “much more organised” and “it’s been really positive”.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and staff had received appropriate training in dealing with medical emergencies.

People 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.

People were protected from the risk of infection because appropriate guidance had been followed and instruments were reprocessed using appropriate techniques in equipment that had been regularly tested and serviced.

There were enough qualified, skilled and experienced staff to meet people’s needs.

There was an effective complaints system available.

We spoke to three people who were visiting the practice for examination and/or treatment. Comments included, “very good, I wouldn’t come back other wise”, “ten out of ten”, “very good”, “extremely polite and friendly”.

We found, people’s privacy, dignity were respected, however, people did not experience care, treatment and support that met their needs and protected their rights.

People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were not protected from the risk of infection because appropriate guidance had not been followed and there were not enough staff with the right knowledge, experience, qualifications and skills to support people.