We carried out this announced inspection on 20 November 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 not 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

The practice is located in Thurnby Lodge, in Eastern Leicester. It 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, within close proximity to the practice.

The dental team includes three dentists, one dental nurse and one trainee dental nurse. The dental nurse and trainee dental nurse also undertake receptionist duties. Practice administration duties are shared between the two principal dentists.

The practice has one treatment room located in a bungalow. The practice have plans to refurbish and update the premises.

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 C M Desai Ltd – Thurncourt are the two principal dentists.

On the day of inspection, we collected 16 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, the dental nurse and trainee dental nurse. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday, Wednesday and Thursday from 9:30am to 12pm, Tuesday and Friday from 1.30pm to 4pm.

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. Most appropriate medicines and life-saving equipment were available. We found that midazolam was not held in the required dose and was in injectable form that was required to be administered into the mouth. The provider acted to rectify this immediately.
• The provider had not managed all risks to staff as they had not taken sufficient measures to mitigate the risk of sharps injuries.
• The practice staff had safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. We were not provided with evidence of up to date training for one of the dentists on the day of our inspection. This was completed on the same date and sent to us after the inspection.
• The provider had thorough staff recruitment procedures.
• Not all clinical staff provided patients’ care and treatment in line with current guidelines. We found a lack of detailed record keeping in patient notes.
• The practice was providing preventive care and supporting patients to ensure better oral health in line with the Delivering Better Oral Health toolkit.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• 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 had systems to deal with complaints; insufficient information was provided to complainants about external organisations that may be able to assist them.
• Governance arrangements required strengthening including audit activity.

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.
• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

Full details of the regulations 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 practice’s handling protocols of out of date medicines to ensure waste is segregated and disposed of in compliance with the relevant regulations and taking into account the guidance issued in Health Technical Memorandum 07-01.
• Review the process for examining radiographs and consider the use of an x-ray viewer would be appropriate.

We spoke with three people who attended an appointment on the day of the inspection. People were happy with the care and treatment received and felt well informed about the treatment options available to them. One person said: “You see the care and attention they give me here – I don’t think I would get that anywhere else.”

People were consulted about the treatment options and made informed decisions. One person said: “I never have to make any decisions, I always would go away and think about it and make another appointment.” Records viewed confirmed the people’s treatment was agreed, consent obtained and treatment plan was in place.

People were satisfied with the hygiene and cleanliness of the treatment rooms. Discussion and observation of staff showed there were effective systems in place to reduce the risk and spread of infection. The infection prevention and decontamination policies were up to date; comprehensive and responsibilities clearly defined.

There were effective recruitment processes in place that ensured suitably qualified staff were employed. Discussion with staff and review of records showed staff accessed regular training to maintain their professional registration.

The provider had an effective quality assurance system in place to monitor and manage the quality of service provided. Complaints were listened to and regular patient feedback ensured the practice continued to provide a quality service.