We carried out this announced inspection on 3 December 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 not 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 not providing well-led care in accordance with the relevant regulations.

Background

Aylestone House Dental Practice is located in a suburb of Leicester and provides NHS and (mostly) private treatment to adults and children. At the time of inspection, the practice was not accepting any new NHS patients.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including for blue badge holders, are available in the practice’s car park at the rear of the premises.

The dental team includes three dentists, three dental nurses, three trainee dental nurses and a practice manager. The practice has three treatment rooms; all are on the ground floor.

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 21 CQC comment cards filled in by patients.

During the inspection we spoke with the principal dentist, two dental nurses and two trainee dental nurses. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday from 08:15am to 6:30pm, Tuesday from 08:15am to 5:30pm, Wednesday from 08:15am to 5pm, Thursday from 08:15am to 5:30pm and Friday from 08:15am to 2:30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies, although one staff member had not updated their training within the previous 12 months. Appropriate medicines and life-saving equipment were available; the spare oxygen cylinder was not fit for purpose and a medicine that required cool storage was not managed according to guidance.
• The practice had some systems to help them manage risk to patients and staff. We found areas that required review such as implementing a process for significant/untoward incident reporting.
• The provider had safeguarding processes and we noted that most staff had completed training in safeguarding vulnerable adults and children. We were unable to view a certificate for one of the dental nurses.
• The provider did not have a policy or procedure to support the appointment of new staff. They had not completed all essential recruitment checks at the point of staff appointment. We were informed that a new policy was being implemented after our visit.
• Not all clinical staff provided patients’ care and treatment in line with current guidelines. Dental record keeping did not follow best practice guidance.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided. The last patient survey was undertaken in 2015 however.
• The provider dealt with complaints positively and efficiently.
• Governance arrangements required strengthening including audit activity. We were informed that audit activity would be improved following our visit.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice’s protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
• Review stocks of medicines and equipment and the practice's system for identifying, disposing and replenishing of out-of-date stock.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We spoke with a dentist about how they obtained the consent of people who used the service. We were told about the process of describing treatment options that were available to people and how to present this in a way the person understood.

We spoke with two people who had received treatment at the time of our visit. We asked them about the care and treatment they had received. Comments included: “I feel extremely comfortable coming here", "we've struck lucky" and "I have confidence with the dentist.....they always explain things properly and are honest and reliable".

There were effective systems in place to reduce the risk and spread of infection. We reviewed the infection prevention and decontamination policies and found them to be up to date and comprehensive with responsibilities clearly defined.

We found there were effective recruitment and selection processes in place and staff had access to regular training.

The provider had an effective quality assurance system to monitor the quality of service provided.

We spoke with six people using the service, including two children. Everyone we spoke with was very happy with the treatment and service they received. People felt welcome and felt they were given enough information to make a decision about treatment.

Everyone we spoke with told us they thought the service was clean.