We carried out an announced comprehensive inspection on 15 June 2015 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 providing well-led care in accordance with the relevant regulations.

CQC inspected the practice on 19 September 2014 and asked the provider to make improvements regarding infection control and staffing. We checked these areas as part of this comprehensive inspection and found this had been resolved.

New Image Dental Practice is a general dental practice in Bexhill On Sea offering NHS and private dental treatment. The practice treats adults and children.

The premises consist of a waiting area adjacent to the reception desk and three treatment rooms. There is also a separate decontamination room.

The staff at the practice consist of the practice manager, two dentists, a dental nurse, a trainee dental nurse and two receptionists. The practice employs the services of a part time dental hygienist who carries out preventative advice and treatment on prescription from the dentists.

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.

Our key findings were:

• There were effective systems in place to reduce the risk and spread of infection. We found all treatment rooms and equipment appeared very clean.

• There were systems in place to check all equipment had been serviced regularly, including the suction compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.

• We found the dentists regularly assessed each patient’s gum health and took X-rays at appropriate intervals.

• The practice ensured staff maintained the necessary skills and competence to support the needs of patients.

• The practice kept up to date with current guidelines and was led by a supportive practice manager.

• At our visit we observed staff were kind, caring and put patients at their ease.

• We reviewed six comment cards that had been completed by patients. Common themes were patients felt they received very good service from a helpful and considerate practice team.

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

• Ensure the incident reporting process is complete so that any actions needed can be identified, recorded and monitored.

Ensure the findings of record keeping audits undertaken by the clinical support manager are shared and discussed with the practice manager in order to monitor any improvement actions needed.

We inspected this dental practice due to concerns raised about the recruitment and training of staff and the practice's control of infection procedures.

During this inspection we spoke with the manager, two dentists and a dental nurse. We also looked at the recruitment and training records for four staff members. We found that appropriate checks were undertaken before staff began work and that recruitment procedures were sound. However, at the time of the inspection the practice did not have sufficient numbers of appropriate staff to ensure that the needs of patients were being met.

We found that staff were recruited in accordance with legislative requirements which meant that patients could be assured that the people treating them had been appropriately checked and vetted. We also saw evidence that staff were suitably qualified and trained and that they attended regular training updates.

Staff had received up to date training on infection control. They were able to demonstrate that they followed appropriate procedures in relation to the decontamination of instruments and controlling the risk of infection. However, the practice had not undertaken an up to date audit of infection control to ensure it met the requirements of requirements of the Decontamination Health Technical Memorandum 01- 05 (HTM-01-05). This meant arrangements weren't in place to ensure infection control procedures were being implemented.

We carried out this announced inspection on 26 February 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.

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

Bexhill dental Clinic is in Bexhill and provides NHS and private treatment to adults and children.

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

The dental team includes three dentists, one dental nurse, one trainee dental nurse, one dental hygienists and two receptionists. The practice has three treatment rooms.

The practice is owned by a partnership 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. At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection, we collected CQC comment cards filled in by patients

During the inspection we spoke with two dentists, one dental nurses, two receptionists 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 08.30-17.30 Saturday 09.00-16.00

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. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• 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.
• 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.

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

• Review the providers registration conditions to ensure the regulated activities at Bexhill Dental Clinic are managed by an individual who is registered as a manager.
• Review the practice’s protocols to ensure audits of radiography and sharps prevention 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.
• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the suitability of the premises and ensure all areas are fit for the purpose for which they are being used.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• 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 recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.