We carried out this announced inspection on 4 June 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

Berners Dental Practice is a well-established practice based in Ipswich which provides both NHS and private dentistry to about 13,900 patients. The dental team includes five dentists, eight nurses, two hygienists, a practice coordinator and two receptionists. There are six surgeries and the practice opens from 9am to 5.30pm, Monday to Friday.

There is level access at the rear of the property for people who use wheelchairs and those with pushchairs.

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 nine CQC comment cards completed by patients and spoke with three other patients. We spoke with the owner of the practice, two dentists, three dental nurses and reception staff. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice had effective systems to help ensure patient safety. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control, and responding to medical emergencies.

• Patients received their care and treatment from well supported staff, who enjoyed their work

• Patients’ needs were assessed and care was planned and delivered mostly in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance. Some clinicians were following guidance set out in the Department of Health’s (DOH) Better Oral Health toolkit more closely than others.

• The practice had thorough staff recruitment procedures.

• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.

• Members of the dental team were up-to-date with their continuing professional development and were supported to meet the requirements of their professional registration.

• The practice had effective leadership and a culture of continuous audit and improvement.

• The practice asked staff and patients for feedback about the services they provided. Staff felt involved and worked well as a team.

• The quality of dental care records varied within the practice. Not all clinicians were recording patients’ caries risk effectively or reporting on the radiographs they took.

• Not all clinicians were using rubber dams to protect patients’ airways.

• Untoward events were not always reported appropriately and learning from them was not shared across the staff team.

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

• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• 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 security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.