We carried out this announced inspection on 4 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 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

Clayton Dental Practice is in Newcastle Under Lyme, Staffordshire and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available at the front of the practice.

The dental team includes four dentists, one oral surgeon, one clinical dental technician, seven dental nurses, two of whom also cover reception duties, two dental hygienists, one receptionist and a practice manager. The practice has four treatment rooms.

The practice is owned by an organisation 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 Clayton dental practice is the practice manager. A registered manager is legally responsible for the delivery of services for which the practice is registered.

On the day of inspection, we received feedback from 27 patients.

During the inspection we spoke with two dentists, three dental nurses, one dental hygienist, one receptionist and the practice manager. One of the organisation’s clinical service leads and an area compliance lead were also present to provide support during this inspection. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5.30pm and Saturday from 9am to 1pm.

Our key findings were:

• The practice appeared clean and patients we spoke with confirmed that this was always the case. We noted that areas by worktops in two treatment rooms required re-sealing which would help maintain infection prevention and control standards.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. These were stored in a room which also housed the practice’s boiler. The room was hot on the day of inspection. Staff were not checking the temperature of this room to ensure medicines were stored at the correct temperature.
• The practice had systems to help them manage risk to patients and staff.
• 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. Patients could book appointments on-line via the practice website.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team. Staff said that they were proud to work at the practice.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Review the practice's Legionella risk assessment and implement any recommended actions, 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.’ In particular by following instructions in the legionella risk assessment.

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained. In particular dental chairs were overdue for service, there was no evidence that the vacuum autoclave had been maintained or serviced recently.