We carried out this announced inspection on 26 June 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

Crown House Dental Practice is in Sutton Coldfield and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice. There are no allocated spaces for patients who are blue badge holders but staff told us the staff car park could be used for any patients with mobility difficulties.

The dental team includes one dentist, two dental nurses and a practice manager. The practice manager and dental nurses also carried out reception duties. The practice has two treatment rooms. A third dental nurse was on maternity leave.

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 30 CQC comment cards filled in by patients. In addition 52 patients left feedback online in the two weeks prior to the inspection.

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

The practice is open between 8am and 5pm from Monday to Friday. It is also open on some Saturdays.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance. Some necessary improvements were highlighted and these were actioned swiftly.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures but some improvements were required.
• 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice had systems to deal with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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

• Review the availability of an interpreter service for patients who do not speak English as their first language.
• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
• 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 fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.
• Review the practice's protocol and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• The practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.

We told the provider forty-eight hours before our visit that we were coming. During our visit, we spoke with the dentist, the practice manager and two people who were waiting for treatment. Following our visit, we spoke with four people on the telephone that had recently been to the dentist. All of the six people we spoke with very complimentary about the service they had received. They told us the staff had always been helpful, polite, respectful and sensitive towards them. One person told us, “I have confidence in the staff's skills and the dentist’s expertise’’.

Treatment options were explained to people and they had time to consider their options. This meant a full discussion took place and people were given the information they needed to be able to make an informed decision about their treatment.

The provider had effective infection control procedures. This meant the risk of infection for people using the service was minimised.

Staff received a range of training so that they had up to date knowledge and skills in order to treat people safely when they attended the practice.

There were systems in place to monitor how the practice was run to ensure people received a quality service. This meant people were asked their views about the service. Where people had made suggestions these were implemented.