We carried out this announced inspection on 31 May 2017 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 with remote access to a specialist dental adviser.

We told the NHS England Cheshire and Merseyside area team that we were inspecting the practice. We did not receive any information of concern from them.

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

Bromborough Dental Practice is close to the centre of Bromborough and provides treatment to patients of all ages on a privately funded basis.

The provider has installed a ramp at the front entrance to facilitate access to the practice for wheelchair users. Car parking is available in the practice’s own car park.

The dental team includes two dentists, a dental hygienist, and four dental nurses, one of whom is a trainee. The practice has two treatment rooms. The team is supported by a practice manager.

The practice is owned by a partnership and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a 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 Bromborough Dental Practice is one of the partners.

We received feedback from 18 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to both dentists, one dental nurse and the practice manager. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open: Monday, Tuesday and Thursday 8.30am to 5.30pm, Wednesday 9.00am to 5.00pm, and Friday 9.00am to 12.30pm.

Our key findings were:

• The practice’s clinical and non-clinical areas were clean and uncluttered.
• Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
• Staff provided patients’ care and treatment in line with current guidelines.
• The practice had a procedure in place for dealing with complaints.
• Staff treated patients with dignity and respect.
• The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
• The practice had a leadership structure. Staff felt supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The practice had infection control procedures in place. Minor improvements were needed to these.
• The practice had systems in place to help them manage risk. There were some areas in which risk could be reduced further.
• The practice had staff recruitment procedures in place. Some improvements were needed to these.

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

• Review the practice's recruitment policy and procedures to ensure character references for new staff as well as proof of qualifications, where appropriate, are requested and recorded suitably.
• Review the practice’s system for assessing, monitoring and mitigating the various risks arising from undertaking of the regulated activities, specifically in relation to waste security externally, display of radiation warning signs, and staff immunity.
• Review the practice’s infection control procedures and protocols, including in relation to the frequency of infection control audits, taking into account guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the storage of dental care records to ensure they are all stored securely, specifically paper based dental care records.

People spoken with who used the service were very positive about the care and treatment they received and spoke highly of the staff team. They told us they felt they had enough time and information to make a decision about their treatment and the dentists talked through all the different treatment options and costs. They also reported that appointments were flexible to meet their needs and the practice was accessible, comfortable and clean. People who used the service made the following comments;

"I never feel rushed when I come here everything is explained and I am given time to make decisions about the treatment options discussed with me.”

“I have recommended this practice to friends and relatives, I am very happy with the service I receive.”

“I had an emergency and needed to see my dentist urgently it wasn’t a problem I came in straight away and was treated.”

"I have no concerns about the cleanliness of the practice.”

"Whenever I come here the waiting room and treatment rooms are always very clean."