We carried out an announced comprehensive inspection on 7 February 2017 to ask the practice the following key questions;

Are services safe, effective, caring, responsive and well-led?

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

Cookham Dental is a dental practice providing NHS and private treatment for both adults and children. The practice is based in a purpose built premises in Cookham, a village close to Maidenhead in Berkshire.

The practice has three dental treatment rooms of which two are based on the ground floor and a separate decontamination area used for cleaning, sterilising and packing dental instruments. The ground floor is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs eight dentists, two hygienists, one nurse, five trainee nurses, one receptionist and a practice manager who is managing the practice for part of the week while a new manager is recruited. A number of agency nursing staff also regularly work at the practice.

The practice’s opening hours are between 8am and 8pm Monday to Friday and 9am to 1pm on Saturday.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service, via 111.

As a condition of their registration with the CQC, the provider is required to ensure that the regulated activities are managed by an individual who is registered as a manager in respect of those activities at Cookham Dental Practice. At the time of the inspection there was no registered manager in place. We were told the previous post holder had left and a new practice manager was being recruited and would become a registered manager when their recruitment was complete.

A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We obtained the views of 10 patients on the day of our inspection. These provided a positive view of the services the practice provides. Patients were happy with the quality of care provided by the practice.

Our key findings were:

• We found that the ethos of the dentists and the dental hygienists was to provide patient centred dental care in a relaxed and friendly environment.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The dental treatment rooms appeared clean and well maintained.
• We noted that a wall in the waiting area was suffering from damp.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Infection control procedures were generally effective and the practice followed published guidance. We noted however that the pre-cleaning sterilisation room had several deficiencies. We saw that the working surfaces and the sinks were covered with hard water stains.
• The practice had processes in place for safeguarding adults and children living in vulnerable circumstances.
• There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• There was not an effective system in place to collate and maintain the training records of staff.
• Staff did not always feel supported by the senior management team of the company.
• Patient feedback during our inspection gave us a positive picture of a friendly, caring, professional and high quality service.
• The practice had clinical governance and risk management structures in place, but we found several shortfalls in systems and processes underpinning the quality of care provided.
• Areas we found that required improvements included policies not being current, staffing numbers, the storage of substances hazardous to health, fire safety and CQC incident notification.

We identified regulations that were not being met and the provider must:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking the regulated activities. For example fire safety management and domestic waste storage.
• Ensure the training, learning and development needs of staff members are collated and reviewed at appropriate intervals.
• Establish a system to ensure that all staff receives practice updates and shared learning.
• Ensure agency staff checks meet the requirements of Schedule 3 of the Health and Social Care Act.
• Ensure that notifiable incidents relevant to the Care Quality Commission are actioned appropriately.
• Ensure the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations is stored securely.
• Ensure that practice infrastructure is maintained to an appropriate standard.

There were areas where the provider could make improvements and should:

• Provide an annual statement in relation to infection prevention control required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Consider the provision of an external name plate providing details of the dentists working at the practice including their General Dental Council (GDC) registration number in accordance with GDC guidance issued in March 2012.
• Review the storage arrangements of the emergency medicines and lifesaving equipment so that they are stored in a central location in the practice and review the availability of a system for dealing with minor injuries to the eye.
• Review the contents of the practice website, practice leaflet and NHS Choices to bring information up to date.
• Ensure the practice complaints procedure includes the correct named person to deal with complaints.

Further to the outcome of a previous inspection, carried out in February 2017, we carried out an announced focused inspection relating to the well led provision of services on 21 June 2017 to ask the practice the following key question;

Are services well-led in relation to governance; specifically management of staff training records, management of fire safety, upkeep of the building, domestic waste storage facilities, the sharing of practice updates and storage of substances subject to COSHH regulations?

We spoke with three people who had recently received treatment at the dental practice. Everyone we spoke with told us the staff treated them with respect. One person said, "I would recommend them. They make me feel special when I visit. They establish a good patient relationship".

The staff checked people's medical history prior to the consultation. We observed the dentist also performed a comprehensive oral examination and the dental nurse assisted with the recording of the treatment plan on the computer.

There were effective systems in place to reduce the risk and spread of infection.

Staff we spoke with were aware of what to do if a person should raise a concern. This included documenting what the issue was, responding in writing promptly, investigating the matter and communicating the outcome to the person.