We carried out this announced inspection on 8 January 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

Birchwood Dental Practice is in Great Wyrley, Staffordshire and provides both 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 at the front of the practice. Car parking spaces for blue badge holders, are available near the practice.

The dental team includes six dentists, nine dental nurses (including one senior nurse and one trainee), one dental hygienist, one dental hygiene therapist and two receptionists. The practice has five treatment rooms.

The practice is owned by an organisation 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 Birchwood Dental practice 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 received feedback from 28 patients.

During the inspection we spoke with three dentists (including the principal dentist), three dental nurses and one dental hygienist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 9am to 7pm, Tuesday to Friday 9am to 5.30pm and Saturday 9am to 1pm by appointment only.

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. Three staff required update training regarding basic life support.
• The practice had systems to help them manage risk to patients and staff although some improvements were required such as the servicing of emergency lighting and the fire alarm and the provision of electrical and gas safety certificates.
• 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 security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.
• Review staff training to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• 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.

This inspection was part of our scheduled programme. We informed the practice we would be visiting two days in advance. During the inspection we spoke with staff that worked at the practice including dentists and dental nurses. We also spoke with people that used the practice.

People that attended the practice were pleased with the dental care they received. Several people told us they would recommend the service to other people. The practice was flexible providing appointments at a time that suited people. The practice took account of people's individual needs. Where people had medical conditions these were taken account of prior to treatment.

People told us that the practice was always clean and hygienic. Systems were in place to make sure that the risk of cross infection was minimised although actions taken were not always recorded. The practice was making sure that all dental instruments were cleaned and sterilised between uses. Dental staff and people that used the service were provided with protective equipment. An infection control audit had been completed but the practice needed to make sure that there was an on-going programme of audits.

The practice's recruitment procedure needed to improve. Most checks were completed but there were no records to confirm that references of staff's suitability had been obtained.

The practice was checking the quality of the service it provided to people. People views were sought and acted upon.