We carried out this announced inspection on 06 February 2019 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

Elm Villa Dental Practice is in Chesterton, Newcastle under Lyme and provides NHS and private treatment to adults and children. The provider also owns a practice in Madeley.

The practice is accessed by steps at the front of the building and therefore is not accessible for patients in wheelchairs. The provider also owns a practice in Madeley, Crewe which does have wheelchair access and patients requiring this can be treated there. Car parking spaces, including some for blue badge holders, are available in a nearby public car park or the streets surrounding the practice.

The dental team includes five dentists, five dental nurses, two trainee dental nurses, a dental hygiene therapist, a clinical dental technician, an operations manager, a practice manager 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 Elm Villa Dental Practice is the principal dentist.

On the day of inspection, we collected 19 CQC comment cards filled in by patients.

During the inspection we spoke with four dentists, two dental nurses, one trainee dental nurse, one receptionist, the operations manager 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: from 9am to 5.30pm.

Tuesday: from 9am to 5.30pm.

Wednesday: from 9am to 6pm.

Thursday: from 9am to 6pm.

Friday: from 9am to 5pm.

Saturday: By appointment.

Our key findings were:

• Strong and effective leadership was provided by the principal dentist and empowered managers.
• Staff felt involved and supported and worked well as a team.
• The practice appeared clean and well maintained. The practice team was responsible for cleaning the practice and used cleaning schedules to manage this.
• 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.
• The practice had systems to help them manage risk to patients and staff. However, on the day of our inspection the practice did not have complete assurance of one staff member’s Hepatitis B immunity levels and legionella water temperatures had not routinely been recorded. These concerns were rectified within 48 hours of our inspection.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Safeguarding contact details were displayed on a staff notice board. The safeguarding lead was trained to level three.
• The provider 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.
• Staff were providing preventive care and supporting patients to ensure better oral health. They routinely referred patients to their dental therapist through a clear care pathway. A copy of the Delivering Better Oral Health toolkit was available for staff to read.
• The appointment system took account of patients’ needs. Patients could access treatment and urgent care when required. The practice offered extended hours appointments opening until 6pm on Wednesday and Thursday; and opening on Saturday from 9am to 1pm.
• Training and development was at the forefront in this practice due to the principal dentist previously being a verified trainer to support newly qualified foundation dentists, and the practice manager previously working in a training practice.
• 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 protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the practice's Legionella risk assessment and implement any recommended actions, 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 ensuring that monthly water temperatures are routinely recorded and any temperatures that fall outside of the recommended range are reported and investigated.

The service provided safe and effective treatment to people and supported people to be involved at all stages. People felt that they were given opportunities to discuss their treatments and that staff and dentists took time to explain things to them. A person said, "The dentist explains everything he is very good."

The provider took account of any special needs that people had and the systems in place ensured that staff were always aware of these. The dentists and staff were responsive to the needs of people and fitted treatment around people's particular preferences and requirements. This helped to ensure that people felt comfortable and at ease.

People who used the service were supported by a skilled staff team who had received the training to deliver the treatment and care they required. The staff team were supported by the provider and manager to achieve and maintain the skills they required to offer high standards of care. The staff felt that the practice was well led. A staff member said, "The staff team are great and the manager and owner are very good."

The environment was well presented, attractive, airy, clean, hygienic and safe, ensuring that people who used the service were protected from the risk of infection. There were plans in place to further improvement the environment.

An effective quality assurance programme was in place to ensure that the services were regularly monitored for their effectiveness and improvements were made where required.