We carried out this announced inspection on 22 August 2018 and 13 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

Bank Cottage Dental Practice is in the market town of Thornbury, approximately 12 miles from Bristol, and provides NHS and private treatment to adults and children. There are two services provided by two independently registered providers at this location. This report only relates to the provision of NHS general dental care and orthodontic services. An additional report is available in respect of the private dental provision which is registered under the provider Bank Cottage Dental Limited.

Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. Orthodontic treatment is provided under NHS referral for children, except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment.

There is a small step into the practice from the street although a portable ramp can be used if requested for access for people who use wheelchairs and those with pushchairs. Car parking spaces, including several for blue badge holders, are available in car parks near the practice.

The dental team includes three dentists, one orthodontist, eight dental nurses, two dental hygienists, one receptionist, one practice administrator and one practice manager. The practice has six treatment rooms.

The provider is registered as 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 Bank Cottage Dental Practice is the practice manager.

An inspection took place on the 22 August 2018 however due to a lack of key personnel available within the practice an additional date of the 13 September 2018 was subsequently scheduled to complete the inspection. On the first day of inspection, we collected 86 CQC comment cards filled in by patients.

During the inspection process we spoke with three dentists, the orthodontist, five dental nurses, one dental hygienist, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday from 9am to 5pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which mostly reflected published guidance. The practice did not show us any completed infection prevention control audits.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, with the exception of one medicine which had not been stored correctly. This item was immediately ordered and replaced.
• The practice had systems to help them manage risk to patients and staff. At the time of our visit there was scope to strengthen this with additional risk assessments. Some of these were completed and sent to us following our inspection.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Safeguarding contact details were displayed in the practice manager’s office. Both the practice manager and practice administrator had completed a designated safeguarding officer course.
• The provider had staff recruitment procedures. We found that one staff member had not received a documented induction and not all qualifications were held on staff files. These were rectified following our visit.
• 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.
• The appointment system met patients’ needs. Patients could access routine treatment and urgent care when required.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided. Information from 86 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, professional and high-quality service.
• 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 recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.

• Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken for all relevant dental materials and substances.

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review the practice’s audit protocols to ensure infection control audits are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.