We carried out this announced inspection on Monday 11 February 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 not providing well-led care in accordance with the relevant regulations.

Background

Butt Lane Dental Surgery is in Talke, Stoke on Trent and provides NHS and private treatment to adults and children.

A portable ramp is available to provide access for people who use wheelchairs and those with pushchairs. Car parking spaces are available on the road at the front of the practice and on side roads near the practice. There is a car park within a short walk of the practice.

The dental team includes two dentists, five dental nurses, two dental hygiene therapists, a cleaner, an administration assistant and a receptionist. The practice has three treatment rooms.

The practice is owned by a partnership 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 Butt Lane Dental Practice is the principal dentist.

On the day of inspection, we received feedback from 33 patients.

During the inspection we spoke with the principal dentist, four dental nurses, one dental hygiene therapist and one receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday and Tuesday 11am to 2pm and 3pm to 7pm. Wednesday 8.15am to 12.15pm and 1.30pm to 4.15pm. Thursday and Friday 9am to 1pm and 2pm to 5pm.

Our key findings were:

• We received positive feedback from patients about the staff and the dental care they received at the practice.
• The practice appeared visibly clean and well maintained. We noted that the practice did not have all of the appropriate cleaning equipment required.
• 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. Some risk assessments completed by external professionals had passed their expiry date. A further risk assessment was completed following this inspection.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• Quality assurance systems such as clinical audit required improvement. The infection prevention and control audit did not have any learning outcomes or actions recorded. Practice meeting minutes recorded brief details of discussions held regarding audits.
• 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.
• Staff felt involved and supported and worked well as a team.
• 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 is not meeting are at the end of this report.

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

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

• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review the practice’s 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 review the provision of cloth seating and carpeted areas in dental treatment rooms.

We telephoned the provider two days before our inspection to ensure that the relevant staff would be available and that people who used the service would have the opportunity to speak with us.

People who used the service felt informed respected and involved in their treatment. People experienced effective treatment and support which was centred on them and met their individual needs. The provider maintained accurate and confidential records of treatment.

The environment was clean and hygienic and the provider ensured that infection control procedures were followed routinely. A person who used the service said, "It's always very clean and hygienic here." Staff received specific training in infection control and decontamination procedures. This helped to ensure that people who used the service were protected against the spread of infection.

Staff were supported to maintain their professional development and to obtain further qualifications. Staff were supervised and felt supported by the provider. A staff member said, "It's a good staff team here." This helped to ensure that people who used the service were treated by a staff team who had the skills and knowledge to meet their needs.

There was an appropriate system in place for gathering, recording and evaluating information about the quality and safety of the treatment and support the service provided. People were asked for their views and suggestions for improvement and the provider took these into account.