We carried out this announced inspection on 6 June 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information which we took into account.

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

Central Dental Surgery is in Lydney and provides mainly NHS and some private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice and patients who need assistance can park on the area immediately in front of the practice.

The dental team includes two dentists, three dental nurses and one receptionist. The practice has two 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 Central Dental Surgery was one of the two principal dentists.

On the day of inspection we collected 14 CQC comment cards filled in by patients and spoke with one other patient. This information gave us a positive view of the practice.

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

The practice is open: Monday to Friday: 9am to 2pm and 3pm to 5.30pm, Saturday and Sunday: Closed

Our key findings were:

• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team, although appraisals were not carried out regularly.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had staff recruitment procedures, although had only obtained a standard level Disclosure and Barring Service check for dental nurses.
• The practice had systems to help them manage risk but improvements were required in some areas. The fire safety risk assessment did not include reference to the use of Butane or oxygen on the premises.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, although there was no self-inflating bag for use in medical emergencies.
• The practice was clean and well maintained, although cleaning equipment and storage was not in line with current guidelines.

• The practice had infection control procedures which mainly reflected published guidance. Improvements were required as the practice did not complete a new infection prevention and control audit at regular intervals and there was no annual statement available in relation to infection prevention and control as required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Improvements were required as some staff had not undertaken safeguarding training or the minimum training in child safeguarding.
• The dentist provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The practice had not carried out a collated audit of radiographs for one dentist since 2014 and the other dentist since February 2016. The grading and justification for X-rays was not routinely recorded in patient notes.
• Risk assessment for dental caries or periodontal treatment were not routinely recorded in patient notes.

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

• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and infection prevention and control are undertaken at regular intervals to help improve the quality of service. Practice should also ensure that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking the X-ray and quality of the X-ray ensuring the practice is in compliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000.
• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review practice protocols for patient assessments and ensure they are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance.
• Review the use of risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Review availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.