We carried out this announced inspection on 3 July 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Burnham House Dental Practice is in Burnham on Sea and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available on the street near the practice or in a public car par behind the practice.

The dental team includes four dentists, one dental nurse and three trainee dental nurses, one dental hygienist and two receptionists. The practice has three 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. The registered manager at Burnham House Dental Practice is the practice manager.

On the day of inspection we received feedback about the practice from 35 people.

During the inspection we spoke with three dentists, one dental nurse, two trainee dental nurses, one receptionist and the registered manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday and Wednesday 08.00am – 8.00pm
• Tuesday 08.00am – 9.00pm
• Thursday 08.30am – 6.30pm
• Friday 08.00am – 5.30pm
• Saturday 09.00am – 1.00pm once a month
• Out of hour’s information displayed on website and via telephone answering service.

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.
• The practice staff 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.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and 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 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 practice protocols for monitoring and recording the fridge temperature to ensure medicines and dental care products are being stored in line with the manufacturer’s guidance.

• Review the practice infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’ In particular the disinfection of laboratory work and the colour of instrument transportation boxes to comply with guidance and practice policy.

• Review the practice sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. In particular regarding single use syringes and matrix bands.

• Review the practice preparatory processes for extractions and consider implementing the World Health Organisation (WHO) surgical checklist to prevent ‘never events’.

• Review the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular the décor, flooring and equipment in surgery 3.

• Review the practice protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• Review the practice protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

• Review the practice systems and process to follow up referrals made to other/specialist practitioners.

We carried out an announced comprehensive inspection on 31st May and 30th June 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

Burnham House Dental Practice is located in the centre of Burnham on Sea and provides NHS and private treatment to patients of all ages. The practice consists of three treatment rooms, toilet facilities for patients and staff, a reception/ waiting area and a staff room.

The practice treats both adults and children. The practice offers routine examinations and treatment. There are three dentists and a hygienist.

The practice’s opening hours are

8.30 to 17.30 on Monday

8.30 to 21.00 on Tuesday

8.30 to 20.00 on Wednesday

8.30 to 17.30 on Thursday

8.30 to 17.30 on Friday

9.00 to 13.00 0n Saturday

We carried out an announced, comprehensive inspection on 31st May and 30th June 2016. The inspection was led by a CQC inspector who had remote access to advice from a dental specialist advisor. As the inspector was not supported by a second person on the first day they returned to complete the inspection on 30th June.

Before the inspection we looked at the NHS Choices website. In the previous year there had been two comments about the practice which were very positive about the practice and both gave them five stars.

For this inspection six patients provided feedback to us about the service. Patients were positive about the care they received from the practice. They were complimentary about the service offered which they said was satisfactory, very good and excellent. They told us that staff were caring and friendly and the practice was clean and hygienic. We received no negative comments.

Our key findings were:

• Safe systems and processes were in place, including a lead professional for safeguarding and infection control.

• Staff recruitment policies were appropriate however, references were not always obtained before staff started work in the practice. Staff received relevant training.

• The practice had ensured that risk assessments were in place and that they were regularly reviewed.

• The clinical equipment in the practice was appropriately maintained. The practice appeared visibly clean throughout.

•The process for decontamination of instruments followed relevant guidance.

• The practice maintained appropriate dental care records and patients’ clinical details were updated.

• Patients were provided with health promotion advice to promote good oral care.

• Written consent was obtained for dental treatment.

• The dentists were aware of the process to follow when a person lacked capacity to give consent to treatment.

• All feedback received from patients was positive; they reported that it was a caring and friendly service.

• There were arrangements for governance at the practice such as systems for auditing patient records, infection control and radiographs.

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

• Review the recruitment procedures to ensure written references are obtained before new staff start work in the practice.

• Make sure evidence of recruitment checks for staff who transferred to the service is available in the practice.

• Review the process of treatment planning so that plans include options for treatment to help patients to make informed decisions about their care.

• Review the arrangements for patients who have a hearing impairment and consider providing a loop system.