We carried out this announced inspection on 21 January 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 providing well-led care in accordance with the relevant regulations.

Background

Chancery Court Dental Practice is in Retford and provides NHS and private treatment to adults and children.

There is lift access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice.

The dental team includes five dentists, eight dental nurses (one of whom is a trainee), three dental hygiene therapists and a practice manager. The practice has six treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

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

During the inspection we spoke with two dentists, five dental nurses, one dental hygiene therapist, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 9am to 6:15pm

Tuesday – Thursday 9am to 5:30pm

Friday 9am to 3:30pm

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 were available. Except for two items, all emergency medical equipment was in place.
• The practice had systems to help them manage risk to patients and staff. A Legionella risk assessment had not been carried out by a competent person.
• The provider 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• Improvements could be made to monitor staff training.
• 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.

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

• Review the practice's Legionella risk management systems and implement any recommended actions identified on an appropriate risk assessment, 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.
• 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 system to ensure there are processes in place to track and monitor the use of prescriptions and routine referrals.

We visited this service on 22 April 2013 and found some areas of non-compliance. We looked at these again in this visit and found the provider had addressed the concerns and they were now compliant.

We spoke with six patients who used the service, the registered provider, one dentist and the practice manager. We also looked at some records, including the outcome of a recent audit of infection prevention control.

We looked at some information from surveys undertaken by the provider to assess the quality of the service.

We found that the practice was well managed, clean and organised in a way which kept patients at the centre of the way they operated.

Patients told us they received the treatment they wanted in an efficient and organised way. They said they were involved in decision making about their treatment and were able to express their views about the service. One patient told us, “I’ve always come to this dentist and would not go anywhere else. They always explain my treatment and how much it will cost.”

Patients said they always found the environment to be clean and tidy and said that staff wore the right protective equipment when treating them. We saw that the practice had a robust infection control policy and that staff were proactive in implementing it.

The provider had an effective system in place to monitor and improve the service provided to patients.

We saw that confidential information such as patient records were stored securely.

Chancery Court Dental Practice provides dental care for private patients as well as people seeking care through the National Health Service. The registered provider works as the principal dentist and all other dentists are associates.

Some of the records we looked at for staff members did not contain evidence that they had provided any professional references. We also saw that some files did not provide evidence that criminal records bureau checks had been completed. This included the recruitment file of a dentist who had recently been employed.

There is one new dental nurse who has started training but is not yet qualified or registered with the British Dental Council. Another nurse has recently qualified and is pursuing registration. The remaining dental nurses that were employed, have achieved the relevant qualifications and are registered with the British Dental Council.

We saw that the practice was clean and well maintained. We also saw that equipment was suitable, clean and in good order.

However, we did observe that one dental nurse did not leave any time between patients and did not follow the cleaning procedures. We observed two patients entering the surgery for treatment when no cleaning had been carried out.

There was a separate decontamination room where used instruments were cleaned, sterilised and re-packed before being returned to a large storage cupboard.

Staff we spoke with were knowledgeable about cleaning procedures for the surgeries.