We carried out this announced inspection on 12 December 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 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 not 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

Cheddleton Dental Surgery is in Cheddleton and provides NHS and private dental care for adults and children.

Car parking spaces are available in the practice’s dedicated car park adjacent to the practice.

The dental team includes the principal dentist, two dental nurses and a dental hygiene therapist. The practice has two 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.

We received feedback from 26 people during the inspection about the services provided. The feedback provided was positive.

During the inspection we spoke to the principal dentist and the two dental nurses. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday 9.00am to 5.00pm

Friday 9.00am to 1.00pm.

Our key findings were:

• The practice had infection control procedures in place which reflected published guidance.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• Staff knew how to deal with medical emergencies. Appropriate medical emergencies medicines and equipment were available, with the exception of one medicine which was not in the recommended format.
• The provider had staff recruitment procedures in place. These were not always followed.
• Staff took account of some of the current guidelines when providing patients’ care and treatment in line. Not all recognised guidance was followed.
• The dental team provided preventive care and supported patients to achieve better oral health.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints. The practice dealt with complaints positively and efficiently.
• The practice had a leadership and management structure.
• The provider had systems in place to manage risk. Several of these were not operating effectively.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 protocols and procedures for the use of X-ray equipment in compliance with the Ionising Radiations Regulations 2017, specifically in relation to registration with the Health and Safety Executive.
• Review the practice’s system for recording, investigating and reviewing incidents and significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice's protocols and adopt an individual risk-based approach to patient recalls taking into account the National Institute for Health and Care Excellence guidelines.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.

People we spoke with who used the service told us they had been involved in the treatment they received and knew why it was needed. People told us, "The dentist always talks to me and tells me what treatment I am having" and "I am asked to update my medical history and sign before treatment is provided".

People we spoke with told us that the staff were always polite and friendly. Staff we spoke with were able to explain the actions they took to reassure people who were nervous and how they ensured that children visiting the dentist felt at ease.

We saw that the service had facilities in place to undertake the decontamination and sterilisation of instruments. Staff we spoke with explained the processes that they need to follow to ensure that equipment was sterilised correctly.

Staff we spoke with told us that they felt supported by their manager with training and development. We saw records that staff had opportunities to update their professional development.

We saw that the provider had systems in place to monitor and assess the standard of service received.