We carried out this announced inspection on 8 August 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 not 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 not providing well-led care in accordance with the relevant regulations.

Background

Firwood Dental Practice is in Chadderton and provides private dental treatment to adults and NHS treatment to children.

There is level access for people who use wheelchairs and those with pushchairs. The practice has two parking spaces, with additional on street parking available nearby.

The dental team includes one dentist, one dental nurse, and a receptionist. A dental implantologist attends as necessary, approximately three times a year. The practice has one treatment room.

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 Firwood Dental Practice was the dentist.

On the day of inspection, we received feedback from 55 people about the services provided. The feedback provided was positive.

During the inspection we spoke with the dentist, the dental nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Thursday 9:30am to 1pm and 2pm to 6pm

Wednesday 9:30am to 1pm and 2pm to 7pm

Friday 9:30am to 2pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which broadly reflected published guidance.
• Staff knew how to deal with emergencies. Improvements were needed to the life-saving equipment available.
• The practice had systems to help them manage risk.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• Care and treatment provided was not always consistent 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 processes for the assessment and monitoring of oral health required improvement.
• The appointment system met patients’ needs.
• 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 had systems to deal with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

We identified regulations the provider was not meeting. They must:

• Ensure the care and treatment of patients is appropriate, meets their needs and ensures their preferences are recorded.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider is not meeting are at the end of this report.

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

• 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 examination of instruments before sterilisation and testing the efficacy of ultrasonic cleaning).

• Review staff training to ensure that all staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.

• Review the practice's waste handling protocols to ensure gypsum waste is segregated and disposed of in compliance with the relevant regulations, and taking into account the guidance issued in the Health Technical Memorandum 07-01.

• Review the fire safety risk assessment and ensure that ongoing fire safety management is effective.

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.