We carried out this announced inspection on 13 December 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

The practice is located in Desford, a village in the Hinckley and Bosworth district, seven miles west of the centre of Leicester. It provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available in the practice’s car park.

The dental team includes five dentists, (including one foundation dentist), one hygiene therapist, three dental nurses, three trainee dental nurses, one decontamination assistant, one dental hygiene therapist, three receptionists and a practice manager.

The practice is an approved training practice for dentists new to general dental practice. The principal dentist and the joint owner are trainers.

The practice has four treatment rooms, all are on the ground floor.

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 35 CQC comment cards filled in by patients.

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

The practice is open: Monday and Tuesday from 9am to 7pm, Wednesday and Thursday from 9am to 5pm and Friday from 9am to 4:30pm. The practice is closed during lunchtimes between 1pm to 2pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. We noted that not all sizes of clear face masks were held or adrenaline in child form. An order was immediately made by the practice to obtain these items.
• The practice had most systems to help them manage risk to patients and staff. We noted that premises management arrangements required some strengthening. Immediate action was taken after the inspection took place.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures. The arrangements required strengthening as not all dental nurses had received a DBS check to show their suitability to work with patients and a reference had not been sought for one member of the team.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• All but one employed staff member had received an annual appraisal.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
• Review the practice’s current performance review systems and have an effective process established for the on-going assessment and supervision of all staff.

We spoke with eight patients, one representative of a patient and seven members of staff. We also reviewed six electronic dental records and five staff files.

The patients told us that their treatment had been discussed and that they were able to make an informed decision about their treatment. One patient told us: “My dentist explained everything fully to me. I knew what to expect before, during and after my treatment.”

We asked people for their views in relation to the care and treatment they received. All spoke highly regarding the quality of care and professionalism displayed by the staff. One patient told us: “I am very nervous but my dentist explains everything to me. They are very gentle.

During our visit we observed and spoke with staff, who were able to demonstrate their awareness and knowledge of prevention and control of infection practices.

There was a process for checking and recording professional registration. We saw that all dental treatment was provided by qualified dentists and the dental nurses were registered with the General Dental Council (GDC), the professional regulator of dental practitioners.

People who used the service and staff were asked for their views about their care and treatment and they were acted on. The practice manager showed us a range of patient surveys and we saw that changes had been made as a consequence of patients’ views.