We carried out this announced inspection on 5 April 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

Bupa – Carre Street is located in Sleaford, a market town in Lincolnshire and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. There are no patient parking facilities on site. There are public car parks in the local area and one located within close proximity of the practice. This includes parking for blue badge holders.

At the time of our inspection, the dental team included five dentists, two locum dentists, six dental nurses, two dental hygienists and two receptionists. The practice had also recruited an additional associate dentist, a hygiene therapist and a receptionist who were all due to start working in the practice shortly after our inspection took place.

At the time of our inspection, the practice were not accepting new NHS patients for registration. We were informed that the practice intended to re-open their list in approximately one month.

The practice has eight treatment rooms; four of these are located on the ground floor.

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. The new practice manager at Bupa – Carre Street had applied to the Care Quality Commission to undertake the registered manager role and this was being processed at the time of our inspection.

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

During the inspection we spoke with two dentists, five dental nurses, one dental hygienist, two receptionists, the practice manager and a clinical support lead who works for the provider. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday, Tuesday, Wednesday, Thursday and Friday from 8am to 8pm, Saturday and Sunday from 9am to 1pm.

The practice offers emergency dental care to people who are not required to be registered with the practice. This service is provided to people who contact NHS 111 with a dental emergency.

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 most systems to help them manage risk. We found that the systems for incident reporting and investigating required improvement.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had implemented staff recruitment procedures, although we found improved monitoring was required.
• 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. Additional staff had been recruited to continue to improve access arrangements.
• The practice had effective leadership and was developing a 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 staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s recruitment procedures to ensure that appropriate checks are completed prior to any new staff commencing employment at the practice.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.

Patients we spoke with said that treatment procedures were clearly explained to them, they were advised of the options available and supported to make an informed choice in their subsequent treatment.

They said they felt as though they were listened to and were encouraged to ask questions.

Appointments were freely available at a time to suit the patient, including evenings and weekends.

Patients told us that their care was centred on them individually and they felt safe.

They told us that they always found the surgeries very clean and that staff always wore protective clothing and gloves.