We carried out this announced inspection on 1 June 2017 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.

We told the NHS England Cheshire and Merseyside area team that we were inspecting the practice. We did not receive any information from them.

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

Deacon Dental Limited is close to the centre of Widnes and provides treatment to patients of all ages on an NHS and privately funded basis.

The provider has installed a ramp at the entrance to the practice to facilitate access for wheelchair users. Car parking is available near the practice.

The dental team includes five dentists, four dental hygienist / therapists, 11 dental nurses, of whom four are trainees, four receptionists, and an administration clerk. The practice has five treatment rooms. The practice also offers orthodontic treatment provided by a Consultant in orthodontics.

The practice is owned by a company and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a 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 Deacon Dental Limited is the principal dentist.

We received feedback from 34 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to three dentists, six dental nurses and two receptionists . We looked at practice policies, procedures and other records about how the service is managed.

The practice is open: Monday and Thursday 8.30am to 5.00pm, Tuesday 8.30am to 9.00pm, Wednesday 8.00am to 7.00pm and Friday 8.30am to 4.00pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
• Staff provided patients’ care and treatment in line with current guidelines.
• The practice had a procedure in place for dealing with complaints.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
• The practice had a leadership structure. Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The practice had systems in place to help them manage risk. These could be improved.
• The practice had staff recruitment procedures in place which could be improved.

We identified areas of notable practice which had a positive impact on patient experience and health outcomes.

The practice was currently in the process of establishing a patient participation group.

Staff told us that they currently have individual patients for whom they need to make adjustments to enable them to receive treatment. Staff described numerous examples of this including agreeing best appointment times for patients with learning difficulties and complete flexibility with patients undergoing treatment for cancer.

The practice had also considered and responded to the needs of vulnerable groups, for example, children requiring emergency appointments were always seen the same day regardless of whether they were a patient of the practice or not.

Children and vulnerable adults who failed to attend dental appointments were proactively followed-up by the dentists.

The practice also provided late evening NHS or private orthodontic appointments to enable children of secondary school age to attend outside school hours.

Staff had access to interpreter and translation services for people who required them. The practice had a hearing induction loop available. Braille signs were in place throughout the practice and staff asked patients who were hard of hearing by which method they preferred to communicate.

A number of handrails had been installed to assist patients with mobility difficulties.

Staff had completed training in dementia awareness. Following this they had assessed the practice and made a number of improvements, for example, improving contrasts and eliminating potential shadows and dark areas.

The practice had large print forms available and also provided a magnifying glass for patients’ use.

A number of patients commented at the inspection and on patient comment cards that these arrangements had made a significant difference to their ability to receive dental care.

We believe this to be notable practice worth sharing as it demonstrated a commitment to identifying and responding to the needs of individual patients and to the needs of vulnerable groups and supporting patients to achieve positive outcomes in respect of their oral health.

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

• Review the practice’s system for assessing, monitoring and mitigating the various risks arising from undertaking of the regulated activities, specifically in relation to the potential risks to staff working in a clinical environment where the effectiveness of the Hepatitis B vaccination is unknown, and the potential risks from lack of staff Legionella awareness.
• Review the protocol for maintaining accurate, complete and detailed records relating to employment of staff. This includes ensuring recruitment checks are carried out and suitably recorded.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and of Gillick competency.

The people that used the practice told us they were happy with the service provided. They

felt they were given enough information about their treatment options and fees and were

able to ask questions.

They said that appointment times were flexible, the clinic was clean, that staff were friendly and treated them with respect. Some comments made by patients were:

"I have been coming here for a number of years. It's an excellent service."

"The service is brilliant. Everything is explained to me."

Feedback left on the National Health Service website in the last 12 months showed that people were happy with the service provided and would recommend it to others.