We carried out this announced inspection on 04 December 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 not providing well-led care in accordance with the relevant regulations.

Background

Bupa - Healaugh Park is in Yarm and provides NHS and private treatment to adults and children.

The dental practice is sited in a purpose-built building with level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including designated spaces for blue badge holders, are available near the practice.

The dental team includes eight associate dentists, eight dental nurses, two dental hygiene therapists and two receptionists. The practice has six treatment rooms. A new practice manager will be commencing in a months’ time; a practice manager from a sister practice is currently overseeing management.

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.

On the day of inspection, we collected nine CQC comment cards filled in by patients which provided a positive view of the practice.

During the inspection we spoke with six dentists, six dental nurses, the stand-in practice manager and the clinical support lead. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday 8.15am to 7pm

Friday 8.15am to 5pm

Saturday 9am to 3pm

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.
• The practice had systems to help them manage risk to patients and staff. These systems could be improved in relation to radiography and risk control measures.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures. These should be reviewed to ensure consistency.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Processes for reviewing training in immediate life support and sedation procedures were not in place.
• 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 leadership. This could be improved.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

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

• Review the providers registration conditions to ensure the regulated activities at Bupa - Healaugh Park, Yarm are managed by an individual who is registered as a manager.

We found that people were treated by courteous staff. We saw that information about their treatment options and costs was on display in the reception. People told us they found the staff to be extremely helpful and the dentist delivered a good service. People who had treatment were given all the information they need to make a decision about which option to take.

Records held by the practice showed that people’s relevant medical history was considered prior to treatment and they showed that screening and checks were carried out during consultations. The staff had been trained to deal with foreseeable medical emergencies and the practice maintained all the necessary equipment needed to deal with any such situation.

The practice had procedures to ensure that the risk of cross contamination and infection were managed and minimised. Also that the equipment was sterilised, stored appropriately and used within the specified timescales. People who received treatment at the dental practice were treated in an environment that was clean and hygienic.

When we looked at the recruitment process, we found that staff were recruited appropriately and that pre employment checks had been carried out. The practice also had a system in place to ensure the service continuously operated safely and in line with expectations for dental services.