We carried out this announced inspection on 24 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

The practice is located in Birstall, a large village within the Charnwood borough of Leicestershire. It provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking is not available at the practice; there is free on road parking within close vicinity to the premises.

The dental team includes four dentists, five dental nurses, two trainee dental nurses, one decontamination nurse and one receptionist. Two of the dental nurses were also undertaking practice management roles.

The practice has four treatment rooms; two are on the ground floor.

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 47 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, five dental nurses, a trainee dental nurse and the receptionist. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 6pm and Saturday by prior arrangement 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 most life-saving equipment were available. Oropharyngeal airways and a child self-inflating bag with reservoir were not held in the kit.
• The practice had most systems to help them manage risk to patients and staff. We noted exceptions in relation to some of the premises management. These were actioned immediately by the provider.
• The provider had some suitable safeguarding processes; we identified that a number of staff had last updated their safeguarding training over three years ago. Following our inspection, action was taken immediately by all the staff to complete this.
• The provider had thorough staff recruitment procedures. Improvements could be made to also have a supporting recruitment policy to underpin their procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines. We noted that improvements were required in relation to the detail of record keeping.
• 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.
• We received many positive comments from patients about the service received.
• 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 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 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 protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

• Review the practice’s protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.

We inspected this location on the 14th January 2013 and returned to check on the improvements since our last visit. The provider had made improvements around the infection control, staff recruitment and quality assurance standards. This means there were improved outcomes for people who used the service and the services's staff. We saw the provider was monitoring the quality of service that people received on a regular basis, and evaluated the the information about the quality and safety of the care, treatment and support the service provides, and its outcomes.

We spoke with four patients and they confirmed they had been asked to provide consent about the care and treatment they received, and that staff always provided the information they needed to make an informed choice. One patient told us: "I have been coming here for years with all my family. The dentist is very calm and treats me well." Another person told us the dentist had referred her to the hospital as she had an ailment in her mouth and was pleased she had gone to the hospital and received treatment. Patients told us that they could always get in touch with the service and never had any difficulties in making an appointment.