We carried out this announced inspection on 9 April 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 not providing well-led care in accordance with the relevant regulations.

Background

Blyburgate Dental Surgery is a well-established branch practice based in Beccles that provides both NHS and private dental treatment. There is a main practice close by and between them, they provide dental services to about 23,000 patients. Some of the staff work across both sites, and the team in total consists of nine dentists, one hygienist and 20 dental nurses. At this site there are four treatment rooms.

The practice opens on Mondays to Thursdays from 9 am to 5pm, and on Fridays from 8 am to 3.30 pm.

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 21 CQC comment cards completed by patients. We spoke with one dentist, one dental nurses and reception staff. We also spoke with two patients.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring and professional service.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff provided preventive care and supported patients to ensure better oral health.
• Patients’ complaints were dealt with positively and efficiently.
• The management of risk was limited and potential hazards within the practice had not been fully assessed to reduce potential harm.
• The practice’s sharps procedures were not in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• The quality of recording in patients’ dental care records was variable and did not always take into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Pre-employment checks were not always undertaken to ensure staff were suitable to work with vulnerable adults and children.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare Products Regulatory Agency (MHRA).

• 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 practice's protocol and staff awareness of their responsibilities under the Duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Review the practice’s responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

We spoke with four people attending for appointments and with their permission we accompanied two people during their consultation and treatment. All praised the relaxed, friendly atmosphere and spoke positively about the quality of the service. One person told us that staff were, “Very good with children.” Another person who was very anxious about going to the dentist said, “To be honest with you, it’s been brilliant; I wish I had come before, (dentist’s name) has been excellent.”

People told us they felt respected by staff and were fully involved in the decisions about their dental care and treatment. One person said that, “Staff are always accommodating and very professional.”

When we asked people if they would recommend the service to others, they told us they would. One person replied, “I always recommend,” the service, especially their dentist as, “You can see they love their job.”

We observed that the reception and clinical areas were clean and tidy. As we gave short notice of our inspection, we asked people if they always found it to be of the same standard. They told us it did. One person said, “I can’t fault it, I have never had a problem with the standard of cleanliness.”