We carried out this unannounced inspection on 5 March 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

Chesham Dental is based in Chesham and provides NHS and private treatment to patients of all ages.

There is level access, via a lift, for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available outside the practice.

Chesham Dental has leased space in a building occupied by two GP practices and several health support agencies. The building is owned by a property management company. We will refer to the property company as the landlord in this report.

The dental team includes six dentists, five trainee dental nurses, two hygienists, three receptionists and a part time practice manager.

The practice has three treatment rooms, a decontamination room, office and reception.

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.

The provider has chosen to appoint a registered manager at Chesham Dental. This person is the practice manager.

On the day of our inspection we obtained the views of 19 patients.

During the inspection we spoke with three dentists, one trainee dental nurse, the practice manager and the provider. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• 8.30am to 5.30pm Monday, Wednesday and Friday
• 8.30am to 8.00pm Tuesday and Thursday
• 8.30am to 1.00pm Saturday

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance but improvements were needed.
• Staff knew how to deal with emergencies. Improvements were needed to ensure appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk but did not operate these effectively.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children but training required improvement.
• Improvements were needed to staff recruitment procedures.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice did not ask for patient feedback about the services they provided.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The management of staff training was not effective.
• Staff felt involved, supported and worked well as a team.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The practice did not have effective clinical and management leadership or a culture of continuous improvement.
• We have been provided evidence to confirm all but two of the shortfalls identified have been addressed. The two areas outstanding are management of staff training and effective staff recruitment processes.

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

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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 protocols for ensuring that all clinical staff have adequate
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Review the practice's processes and systems for seeking and learning from with a view to monitoring and improving the quality of the service.