We carried out an announced comprehensive inspection on 30 March 2016 to ask the practice the following key questions; are services safe, effective, caring, responsive and well-led?

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

Brunner Court Dental Practice is located in the centre of Northwich and comprises a reception and waiting room, two treatment rooms, an office and staff room and a decontamination room on the ground floor. Parking is available on nearby streets and in car parks. The practice is accessible to patients with disabilities, impaired mobility and to wheelchair users.

The practice provides general dental treatment to patients on an NHS or private basis, and is open Monday 8.30am to 5.00pm, Tuesday 9.00am to 5.00pm, Wednesday and Thursday 8.30am to 6.00pm, Friday 8.30am to 4.00pm and Saturday by appointment. The practice is staffed by a practice manager, three dentists, one dental therapist, one dental hygienist, one receptionist and three dental nurses, one of whom is a trainee.

One of the principal dentists is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We spoke to three patients during the inspection about the services provided. Every comment was positive about the staff and the service. Patients commented that they found the staff helpful, kind and and caring. They said that they were always given explanations about dental treatment and choices.

Our key findings were:

• The practice had procedures in place to record and analyse significant events and incidents and acted on safety alerts.
• Staff had been trained to deal with medical emergencies and emergency medicines and equipment were available.
• Premises and equipment were clean, secure and well maintained.
• Infection control procedures were in place and the practice followed current guidance.
• Patients’ needs were assessed and care and treatment were delivered in accordance with current legislation, standards and guidance.
• Patients received explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• We observed that patients were treated with kindness, dignity and respect and their confidentiality was maintained.
• The appointment system met the needs of patients, and emergency appointments were available.
• Services were planned and delivered to meet the needs of patients and reasonable adjustments were made to enable patients to receive their care and treatment.
• The practice gathered the views of patients and took into account patient feedback.
• Staff were supervised, felt involved and worked as a team.
• Governance arrangements were in place for the smooth running of the practice although some improvements to these could be made.
• Staff had received safeguarding training but not all to the level appropriate to their role and they were not fully familiar with the process to follow to raise concerns.
• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients but the recruitment process was not in accordance with regulations.

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

• Review the practice’s arrangements for responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the frequency of checks on emergency equipment having due regard to guidelines issued by the Resuscitation Council (UK) and the General Dental Council standards for the dental team.
• Review the practice's recruitment procedures to ensure they are in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is retained.
• Review the practice’s safeguarding policy and staff training ensuring it covers both children and vulnerable adults and all staff are trained to an appropriate level for their role and aware of their responsibilities.
• Review staff awareness of Gillick competency and the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities.
• Review the practice’s waste arrangements to ensure waste is securely stored in accordance with relevant regulations having due regard to guidance issued in the Department of Health Health Technical Memorandum 07-01 Safe management of healthcare waste.
• Review the practice’s sharps risk assessment, policy and procedures having due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and meet the requirements of their professional regulator.