We carried out this announced inspection on 4 September 2017 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.

We told the NHS England team that we were inspecting the practice. They did not provide any information.

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

Belmont Lodge Dental Health Centre is in Maidenhead and provides NHS and Private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces include space for disabled patients is available behind the practice. We spoke to the practice manager about marking out a bay specifically for disabled person’s blue badge holders. They told us they would review their arrangements.

The dental team includes the practice manager, three dentists, three dental nurses, and two receptionists. The practice treats patients for both NHS and Private treatment.

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 55 CQC comment cards filled in by patients and obtained the views of 14 other patients.

During the inspection we spoke with the practice manager, one dentist, one dental nurses and a receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open 9am to 5pm Monday to Friday and evenings by arrangement.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice 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 appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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

• Review the practice's management of fire safety taking into account current national guidelines and having regard to The Regulatory Reform (Fire Safety) Order 2005.
• Review the practice's recruitment policy and procedures ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review the staff training and development protocols and ensure an effective process is established for the on-going training of all staff.

We carried out an announced comprehensive inspection on 24 March 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Belmont Lodge Dental Health Centre is a small dental practice located on the outskirts of Maidenhead. It is located within a converted house and has provided services from the present location for over 10 years. Treatments are provided both via a small NHS contract and privately. The split between NHS and private treatment is approximately 50/50. The principal dentist employs three trainee dental nurses and two receptionists. There is a part time practice manager. An associate dentist also works at the practice. The principal dentist is approved as a trainer for qualified dentists undertaking their first year in general dental practice and there is a foundation year dentist working at the practice.

The practice is open from 9am to 5pm every weekday. Morning appointments are from 9am to 12.50pm and in the afternoon from 2pm to 4.50pm.

The practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Forty nine patients provided feedback about the service. We spoke with three and 46 had completed CQC comment cards in the two weeks prior to our visit. All 49 were positive about the care they received. The common themes from patient feedback were focussed on how the dentists made patients feel at ease during their treatment, dispelling any fear patients had about dental treatment, and on the dentists giving good explanations of the care and treatment being undertaken.

Our key findings were:

• The practice was well equipped to deal with emergencies. An automated external defibrillator, medical oxygen and emergency medicines were available. Staff had received training in how to deal with an emergency.
• Patients’ needs were assessed and care was planned and delivered in line with general professional and other published guidance.
• Patient feedback was consistently positive about the care and treatment received from the dentists.
• Appropriate arrangements were in place to protect patients from the risks posed by exposure to x-rays.
• Staff received training relevant to their roles and were supported in their continuing professional development.
• Prescription pads were held securely.

However,

• The practice conducted a range of audits including audits of x-ray quality, dental care records and control of infection. However, the audit of control of infection had failed to identify issues with general cleaning standards, disposal of clinical waste, demarcation of the decontamination room and uncovered computer keyboards in treatment rooms.
• Governance arrangements were in place but were operated inconsistently. For example the practice did not demonstrate they had a plan to effect repairs to equipment and had failed to complete a fixed wiring safety check of the premises. Premises checks had not identified issues of poor housekeeping.

We identified a regulation that was not being met and the provider must:

• Ensure the cleaning standards and frequency of cleaning are monitored to confirm consistent standards.
• Ensure the dental chairs are maintained in good order to reduce the risk of cross infection.
• Ensure appropriate segregation of clinical and sanitary waste and have clinical waste removed from the premises at suitable intervals to reduce the risk arising from storage.
• Institute robust checks of treatment rooms to ensure dental materials are appropriately stored to reduce risk of contamination.
• Ensure all current guidance to reduce the risk of cross infection is followed. Including the safe use of computer keyboards in treatment rooms and demarcation of clean and dirty areas in the decontamination room.

You can see full details of the regulation not being met at the end of this report.

There were also areas where the provider could make improvements and should:

• Ensure actions identified in the legionella risk assessment are completed. For example monitoring of hot and cold water temperatures.
• Complete a risk assessment to evaluate whether trainee dental nurses require a DBS check.

We spoke with three people who were using the service at the time of our visit. They told us they were happy with the practice and felt that staff were friendly and treated them with respect. One person said “I came here on a recommendation and think it is super.” Another patient said "I have been coming here for 10 years. They always take their time, there is no rush."

Patients we spoke with told us they were given information about different treatment options and the fees involved. We viewed eight patient records and found these contained appropriate information regarding previous examinations and treatments. Patients were asked to update their medical history every six months. This ensured that dentists were aware of patient’s medical conditions that could be affected by dental treatments.

The practice was clean, hygienic and effective systems reduced the risk of healthcare associated infection. Relevant hygiene and infection control guidance was followed.

Staff undertook appropriate training and were supported to deliver effective care and treatment safely. Staff told us they felt supported by management. We saw staff were appraised annually and attended regular team meetings.

Patients we spoke with were happy with the care provided and no complaints had been raised in 2013. The practice’s complaints procedure was clearly displayed and a comments box was available for patients.