We carried out an announced comprehensive inspection on 12 October 2015 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 providing well-led care in accordance with the relevant regulations

Background

Dentcare1 - Nottingham is a mixed dental practice providing NHS and private treatment and caters for both adults and children. One of the dentists provides dental implants and occasional use of conscious intravenous sedation for patients who are very anxious. The practice is situated in a converted domestic property. The practice had three dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments.

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

Before the inspection we sent CQC comment cards to the practice for patients to complete to tell us about their experience of the practice. We collected 11 completed cards These provided a largely positive view of the services the practice provides.

We carried out an announced comprehensive inspection on 12 October 2015 as part of our planned inspection of all dental practices. The inspection took place over one day and was carried out by a lead inspector and a dental specialist adviser.

Our key findings were:

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.

• Staff demonstrated knowledge of the practice whistleblowing policy and were confident they would raise a concern about another staff member’s performance if it was necessary.

• Patients’ needs were assessed and care was planned and delivered in line with current professional guidelines with respect to general dentistry and conscious sedation.
• Equipment used in the practice was maintained in accordance with the manufacturer’s instructions.
• Infection control procedures were robust and the practice followed published guidance.
• The practice had enough staff to deliver the service.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).
• Staff felt well supported by the registered manager and were committed to providing a quality service to their patients.
• Feedback from patients gave a mainly positive picture of a friendly, professional service.

• There was an effective system in place to act on feedback received from patients and staff.

• There were systems in place to assess, monitor and improve the quality of service provided.

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

• Consider adding oxygen to the existing emergency check list to prevent oversight of the expiry date.

We conducted this inspection to follow up on areas of concern that we had identified at our inspection that took place over two days on 13 and 17 December 2013.

At that inspection we found that the provider had not taken reasonable steps to ensure patients received care and treatment that was safe. We also found that the provider had not taken the necessary action to ensure patients and others were protected from the risk of healthcare associated infections.

As a result of that inspection we asked the provider to take action to address the issues on which we had concerns.

At this inspection we found that the provider had put into place processes and procedures to help ensure that patients were safe when undergoing intravenous sedation and that staff had received the appropriate training to help them deliver care and treatment safely.

We saw that the provider had taken the appropriate measures to help ensure that patients and others were protected from the risk of healthcare associated infections.

We carried out this inspection over two days to check on the care and welfare of people using this service. During the course of our inspection we spoke with patients, members of staff, the registered manager and the nominated individual. We also spoke with the commissioners of National Health Service (NHS) treatments carried on at the practice. On the second day of our inspection we were accompanied and assisted by a specialist dental advisor. Due to concerns identified during our inspection we focused on how people received treatment under conscious sedation.

The practice had a current contract with the NHS to provide NHS dental care to people. Patients could choose to pay for private treatment which was outside the agreed treatments of the NHS or through a dental payment plan.

Treatment could be arranged at a convenient time, and patients told us they did not experience any lengthy delays. Patients could consider their treatment options and any costs involved and did not have to make a decision immediately.

We found that the provider had not taken reasonable steps to ensure patients received care and treatment that was safe and protected their rights.

We found that the provider had not taken the necessary action to ensure patients and others were protected from the risk of healthcare associated infections and did not have in place, the proper procedures to ensure that the clinical treatment rooms were cleaned and maintained to an acceptable standard.