We carried out this announced inspection on 24 May 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

The practice is well-established and located in the small Norfolk town of Fakenham. It provides mostly NHS treatment to adults and children, and serves about 10,000 patients. The dental team includes four dentists, nine dental nurses who also act as receptionists, and one part-time dental hygienist.

There are five treatment rooms and the practice opens from 9am to 5.30 pm Monday to Friday, with late opening on a Wednesday evening until 7.30pm.

There is level access for people who use wheelchairs and those with pushchairs.

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 44 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with the principal dentist, two dental nurses and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice had effective systems to help ensure patient safety. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control, and responding to medical emergencies.

• Risk assessments were robust and action was taken to protect staff and patients.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• Patients received their care and treatment from well supported staff, who enjoyed their work.

• Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration.

• The practice had thorough staff recruitment procedures.

• 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 practice asked staff and patients for feedback about the services they provided. Staff felt involved and supported, and worked well as a team.

• There was no system in place to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.

• Individual prescriptions were not monitored effectively to identify their loss or theft.

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

• Review the security of prescriptions and ensure there are systems in place to monitor and track their use.

• Review the practice’s system for recording, investigating and reviewing incidents with a view to preventing further occurrences and ensuring that improvements are made as a result.

• Review staff awareness of the legal precedent by which a child under the age of 16 years of age can consent for themselves and ensure all staff are aware of their responsibilities.

• 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. In addition to this review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays and its grade.

• Review staff’s understanding of never events and implement local safety procedures for invasive procedures such as tooth extraction.