We carried out this announced inspection on 8 May 2019 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 and a second CQC inspector.

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 not providing well-led care in accordance with the relevant regulations.

Background

Bath Spa Dentistry is in Bath and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes three dentists, one lead dental nurse, four dental nurses, one trainee dental nurse, one dental hygienist, one dental hygiene therapist, one practice manager and one business manager. The practice has three treatment rooms.

The practice is owned by 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 Bath Spa Dentistry is the principal dentist. A registered manager is legally responsible for the delivery of services for which the practice is registered.

On the day of inspection, we collected 18 CQC comment cards filled in by patients and spoke with three other patients.

During the inspection we spoke with one dentist, one lead dental nurse, three dental nurses, one business manager 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 8.45am to 5.15pm

Tuesday 8.45am to 6.15pm

Wednesday 8am to 5.15pm

Thursday 8.45am to 5.15pm

Friday 8.15am to 2.15pm

Our key findings were:

• The practice appeared clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were mostly available.
• The practice had systems to help them manage risk to patients and staff.
• Improvements could be made to the storage of waste materials.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Improvements could be made to the availability of X- ray information.
• Improvements could be made to the administration and testing of the Dental Cone Beam (Computed Tomography) device.
• Improvements could be made to the management and use of safer sharps.
• Improvements could be made to the infection control procedures.
• Improvements could be made to the legionella risk assessment by implementing the recommendations.
• improvements could be made to the safe storage of medicines
• Improvements could be made to the auditing processes.
• The provider 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement.
• Improvements could be made to the staff appraisal process.
• 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 provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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.

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

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

• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the British National Formulary and the General Dental Council.

• Review the practice's waste handling protocols to ensure waste is segregated and disposed of in compliance with the relevant regulations, and taking into account the guidance issued in the Health Technical Memorandum 07-01.

• Review the practice's current performance review systems and have an effective process established for the on-going assessment and supervision of all staff.

• Review the practice’s protocols to ensure audits of radiography, clinical records, antibiotic stewardship and infection prevention and control are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

We spoke with three people who used the service, one dentist (who was the provider) and three staff members.

We found people had a high level of satisfaction with the service provided. One person we spoke with told us "it’s amazing (the practice). They’re gentle. They think about everything to make you comfortable.” Another person said "I couldn’t have more confidence. They’re wonderful (staff), excellent. I’m very satisfied with the treatment.”

People were aware of their treatment costs and were involved in their dental plan. They were able to see their X-rays to gain an understanding of their dental issues.

We found the dentist ensured people's care and treatment was safe and effective. There was emergency equipment available. The provider had all the emergency drugs recommended by the British National Formulary advice for dental practices.

We saw the X-ray equipment had instructions to ensure safe practice when working with X-ray equipment (local rules) and an up to date certificate of examination.

People we spoke with told us they were satisfied with the cleanliness of the practice. Overall the practice met the guidance recommendations of the Department of Health 'Health Technical Memorandum 01-05: decontamination in primary care dental practices' (HTM01-05).

Staff were appropriately qualified. They had regular training updates.

We saw the provider had a system to monitor the quality of the service provided.