We carried out this announced inspection on 7 August 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

Bowdlers House Dental Practice is in Shrewsbury and provides NHS and private treatment to adults and children.

There is no level access for people who use wheelchairs or those with pushchairs. Car parking spaces are available near the practice.

The dental team includes three dentists, one dental hygienist and eight dental nurses (four of whom are trainees). All the dental nurses undertake reception duties. 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. The registered manager at Bowdlers House Dental Practice was the senior partner.

On the day of inspection, we collected 28 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two 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 8:30am to 6pm

Tuesday – Friday 8:30am to 5:30pm

The practice is also open on alternate Saturdays between 8:30am and 2pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice 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. A fire risk assessment had been carried out but the documentation had not yet arrived. The provider had arranged for this to be repeated.
• The practice’s safeguarding processes required improvements. Staff knew their responsibilities for safeguarding adults and children but most staff had not received recent training. This was promptly addressed.
• The practice had staff recruitment procedures but we identified necessary improvements as some of the records were incomplete. These issues were promptly addressed.
• Staff appraisals had not been carried out. The provider informed us these were scheduled to commence in September 2018.
• 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with concerns positively and efficiently.
• Not all staff were aware of their responsibilities under the duty of candour regulation.
• The practice had suitable information governance arrangements.

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

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff. This includes documenting induction procedures for newly recruited staff.
• Review the practice's current performance review systems and have an effective process established for the on-going assessment and supervision of all staff.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.
• Review the practice's protocol and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.