We carried out this announced inspection on 5 May 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 area team that we were inspecting the practice. They did not provide any information which we took into account.

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

Dentalcare Trowbridge is in Trowbridge and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. A small number of car parking spaces were available at the rear of the practice but further public car parking, including for patients with disabled badges, was available near the practice.

The dental team includes four dentists, four dental nurses and three trainee dental nurses, two dental hygienists and two receptionists. The practice has four treatment rooms.

The practice is owned by a company 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 Dentalcare Trowbridge was the practice manager.

On the day of inspection we collected 15 CQC comment cards filled in by patients and spoke with three other patients. This information gave us a positive view of the practice.

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

The practice is open: Monday: 9am to 6pm, Tuesday: 8am to 6pm, Wednesday: 9am to 8pm, Thursday: 9am to 6pm, Friday: 8am to 5pm. Saturday: 9am to 4pm, Sunday: closed.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected current published guidance.
• 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 had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice 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.
• The appointment system met patients’ needs.
• The practice had effective leadership. 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 dealt with complaints positively and efficiently.

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

• Review the practice's waste handling protocols to ensure gypsum waste is segregated and disposed of in accordance with relevant regulations taking into account guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review the practice’s protocols for the use of closed circuit television cameras (CCTV) taking into account guidelines published by the Information Commissioner's Office (ICO).
• Review the arrangements for the use of prescription pads in the practice and how individual prescriptions are logged.

This inspection was to follow up problems with infection control that we identified at our previous inspection in July 2014. At the time of our visit the service did not have a registered manager. The practice manager had applied to become the registered manger and was awaiting the outcome of their application.

During this inspection we talked to the practice manager and a dental nurse. We looked at the surgeries and equipment and we checked records. We sought advice from a specialist dental advisor.

We found that the problems with infection control had been addressed. A cleaning company was now responsible for cleaning the general areas and they had produced cleaning schedules to make sure that cleaning tasks took place. There was a log for cleaning the toilet areas.

Measures had been introduced to control the risks from Legionella. A specialist company were making checks of the water systems. A Legionella risk assessment had been conducted and staff were checking the temperature of the water from both the hot and cold taps to make sure they were within the correct range.

When we went to the dental practice, we spoke with five patients and a parent of a child receiving treatment. These patients told us the care and treatment they received was good. They told us they were involved in the decisions about their treatment and they were told about the cost implications for each available option.

The patients we spoke with told us the staff respected their rights. They described the way staff respected their privacy, dignity and confidentiality. Examples were used to tell us how staff achieved this. We were told staff closed the door to the consultation rooms while treatment was taking place and staff used their preferred names to address patients.

Safeguarding procedures were available and staff knew the signs of abuse and the expectations on them to report allegations of abuse.

Systems for the decontamination of instruments were in place. However, patients were at risk from the spread of infection. Audits and schedules to detect and control the spread of infection and risk assessments to reduce the potential risk of Legionella were not in place.

Quality assurance systems were in place to ensure the views of patients were taken into account in the running of the service and standards were maintained.