We carried out this announced inspection on 31 January 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They provided some information which we took into account.

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 Flitwick, a rural town in Bedfordshire. It provides NHS and private treatment to patients of all ages. At the time of our inspection, the practice were accepting new NHS and private patients.

There is level access for people who use wheelchairs and pushchairs with the use of a portable ramp over a slight step. There are some car parking spaces available at the practice. The practice do not currently have designated parking spaces for blue badge holders. Other payable car parking facilities are also available within short walking distance of the practice.

The dental team includes seven dentists, three dental nurses, five trainee dental nurses, two hygienists, four receptionists and a practice manager.

The practice has four treatment rooms; two of these are on the ground floor. We were informed that plans were in place to refurbish parts of the practice.

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. At the time of the inspection the practice did not have a registered manager in post. The newly appointed practice manager has applied to undertake the registered manager role.

On the day of inspection we collected 17 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with four dentists, two dental nurses, four trainee dental nurses, two receptionists, the practice manager, the compliance manager and the area manager.

We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Friday from 8am to 8pm. The practice has recently started opening on Saturday mornings from 8am to 12pm.

Our key findings were:

• The practice objectives included the provision of a high quality and range of dental services to the whole community through a friendly and professional service.
• Staff had been trained to deal with emergencies and equipment and appropriate medicines were readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected current published guidance.
• Staff were aware of their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• The practice had implemented processes for the reporting and investigating of incidents and accidents.
• Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The practice demonstrated awareness of most of the needs of the local population and took these into account when delivering the service.
• Patients had access to routine treatment and urgent care when required.
• Staff received training appropriate to their roles and were supported in their continued professional development (CPD) by the practice.
• The practice dealt with complaints efficiently.
• Whilst there were governance arrangements, we noted areas where these could be strengthened.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff. This refers particularly to staff immunity to Hepatitis B and ensure that any appropriate action is taken once received.
• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as radiography and infection control are undertaken at regular intervals to help improve the quality of the service. The practice should also ensure that where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Review the current performance review systems in place and have an effective process established for the on-going assessment and supervision of all staff.
• Review its responsibilities to respond to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.