We carried out this announced inspection on 16 May 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

Easton Dental Practice is in Bristol and provides NHS and private treatment to patients of all ages.

There is level access, using a ramp, for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes four dentists, two dental nurses, four trainee dental nurses, one dental hygienist and one cleaner. The practice has three treatment rooms.

The practice is owned by a partnership 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 Easton Dental Practice was the principal dentist.

On the day of inspection we collected seven CQC comment cards filled in by patients and spoke with four other patients.

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

The practice is open:

Monday to Thursday 9am to 5pm

Friday 9am to 3pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected 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 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 dealt 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 practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.
• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’, in particular the reuse of equipment when single use items were available.
• Review the availability of medicines in the practice to manage medical emergencies taking into account the guidelines issued by the British National Formulary and the General Dental Council.

We carried out an announced comprehensive inspection on 28th June 2016

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

Easton Dental Practice is located in Stapleton Road, Bristol and provides mainly NHS treatment to adults and children and some private treatment. The practice consists of three treatment rooms, toilet facilities for patients and staff, a reception/waiting area, a second waiting area and a staff room. The practice offers routine examinations and treatment. There are three dentists and a hygienist. The current providers took over the practice at the beginning of April 2016.

The practice opening hours are:

8.30 to 13.00 and 13.30 to 17.30 on Monday

8.30 to 13.00 and 13.30 to 17.30 on Tuesday

8.30 to 13.00 and 13.30 to 17.30 on Wednesday

8.30 to 13.00 and 13.30 to 17.30 on Thursday

8.30 to 12.30 and 13.00 to 17.00 on Friday

We carried out an announced, comprehensive inspection on 28th June 2016. The inspection took place over one day. The inspection was led by a CQC inspector. They were accompanied by a dental specialist advisor.

Before the inspection we looked at the NHS Choices website. There were two reviews in the past 12 months and both gave one star. However, these reviews related to the practice under the previous provider.

For this inspection 12 patients provided feedback to us about the service through CQC comment cards. We also spoke with three patients. All these patients were positive about the care they received from the practice. They were complimentary about the service offered which they said was good or very good. They told us that staff were professional, caring, helpful and friendly and listened to what they had to say. Patients told us that the practice was clean and hygienic. We received no negative comments.

Two of the dentists are registered with the Care Quality Commission (CQC) as a partnership and are the providers of the service or ‘registered persons’. One of these dentists is also the registered manager and a registered person. 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.

Our key findings were:

• Safe systems and processes were in place, including a lead professional for safeguarding and infection control.

• Staff recruitment policies were appropriate and most of the relevant checks were completed. Staff received relevant training.

• Risk assessments were in place.

• The clinical equipment in the practice was appropriately maintained. The practice appeared visibly clean throughout.

•The process for decontamination of instruments followed relevant guidance.

• The practice maintained appropriate dental care records and these were updated.

• Patients were provided with health promotion advice to promote good oral care.

• Written consent was obtained for dental treatment.

• The dentists were aware of the process to follow when a person lacked capacity to give consent to treatment.

• Feedback that we received from patients was positive. Patients said that they received a caring and effective service.

• There were governance systems at the practice such as systems for auditing patient records, infection control and radiographs.

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

• Review the process of recruitment of staff to make sure references are obtained in line with current guidance about recruitment.
• Review the system for refrigerating medicines so that they are stored in line with current guidance.