We carried out this announced inspection on 7 January 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 providing well-led care in accordance with the relevant regulations.

Background

Bupa - Bradley Street, Castleford provides NHS and private treatment to adults and children. They provide dental implants and treatment under conscious sedation

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes nine dentists, 16 dental nurses, four dental hygienist / therapists, four receptionists, a patient care co-ordinator and a practice manager. The practice has 10 treatment rooms.

The practice is owned by a company 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. At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered. The practice manager was currently applying to be registered manager.

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

During the inspection we spoke with three dentists, three dental nurses, one receptionist, the patient care co-ordinator and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Thursday from 8:30am to 6pm

Tuesday from 8:30am to 8pm

Wednesday and Friday from 8:30am to 5pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Improvements could be made to the system and process to ensure risks associated with fire and the use of X-ray equipment are appropriately managed.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• 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 protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance PHE-CRCE-023 on the safe use of Hand-held Dental X-ray Equipment.
• Review the critical examination for the Orthopantomogram (OPG) machine and ensure actions required are completed.
• Review the practice’s protocol for recording patient’s blood pressure prior to discharge following conscious sedation taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.
• Review the providers registration conditions to ensure the regulated activities at Bupa - Bradley Street, Castleford are managed by an individual who is registered as a manager.

We spoke with four people in the waiting room who were waiting to see a dentist. They all spoke positively about the service they received. They commented that they felt involved in making treatment decisions, dental surgeries were always clean and staff wore protective clothing such as gloves. One person said, "He knows me and my situation very well."

We spoke with seven dental staff including the nominated individual. The dental nurses were able explain the infection control procedures which reflected what was in the organisation's infection and control policy. They and the dentists we spoke with were also able to explain to us how they obtained consent for treatment and how they involved people in making decisions. Again this reflected what was written in the consent policy.

We looked around three of the dental surgeries and the decontamination room. We saw the surgeries were clean and decontamination room had a clear operating system to enable to the effective decontamination of dental equipment.