We carried out this announced inspection on 11 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.

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 Leicester in the East Midlands and provides NHS and private treatments to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces, including one allocated for patients who are blue badge holders, are available at the practice.

The dental team includes nine dentists, five dental nurses, four trainee dental nurses, a decontamination assistant (who works in the decontamination of dental instruments), four receptionists and a practice manager.

The practice has seven treatment rooms; four of these are on the ground floor.

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 our inspection, the practice did not have a registered manager in post. We discussed this with the provider and they informed us they would take immediate action to address this.

On the day of inspection we collected 35 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, five dental nurses, the decontamination assistant, four 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 to Thursday from 9am to 6pm and Friday from 9am to 5pm.

Our key findings were:

• Effective leadership from the partnership and practice manager was evident.
• Staff had been trained to deal with emergencies. Appropriate medicines and most lifesaving equipment was 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.
• The practice had effective processes in place and staff knew their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• The practice had adopted a process for the reporting of untoward incidents and shared learning when they occurred in the practice.
• Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The practice was aware 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 continuing professional development (CPD) by the practice.
• The practice had systems to address complaints and those received were investigated appropriately.
• Staff we spoke with felt supported by the provider and were committed to providing a quality service to their patients.
• Governance arrangements were embedded within the practice.

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

• Review staff training and equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK) and The Intercollegiate Advisory Committee on Sedation in Dentistry document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.
• Review the practice policies and protocols in relation to domiciliary care taking into account the guidance provided by the British Society for Disability and Oral Health.
• 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.

We carried out this inspection to assess whether the provider had made improvements in relation to involving people in their care and in relation to infection control. In addition to assessing these improvements, we also looked at the quality assurance systems at the practice, their recruitment records and how they obtained patient consent to care and treatment.

In order to review these areas we spoke with seven members of staff, including two managers at the practice and two dentists working there. We also spoke with three people who used the service and had done so for some time. None of the people we spoke with had any concerns. They told us that they were happy with their dentist, that they treated them with respect and that the practice always appeared to be clean. Staff working at the practice told us they felt supported and that they worked well as a team. Staff had got the relevant checks in place in relation to their recruitment into the practice.

We found the practice to be consulting people about their care and to be measuring the quality of the care and treatment being delivered. We found that the service had made the improvements required of them in relation to involving people in their care and in relation to their infection control policies and procedures.

We spoke with two people using the service on the day of our visit. One told us the service was “Very nice; very friendly. “ They told us that they were anxious about visiting the dentist, “I used to cry. He used to take his time. If you wanted him to stop, he’d stop and give you some time. They’re more gentle.” The second person told us the dentist was “Marvellous.”

Both people we spoke with thought the dentist was thorough in their assessment. They were given information about their treatment. They were given advice about oral health and the risks, for example, of smoking were explained to them. This showed that the provider assessed risks to people and took appropriate action to address those risks.

Both people we spoke with had had appointments cancelled. One person had been given an explanation for the cancellations and was satisfied. The other person had found it to be a recurring problem and found it inconvenient. Before our visit, we had been contacted by people using the service who were not happy with the service. One person told us they and their partner had had several appointments cancelled without explanation. Another person felt they had not been treated with respect. They thought this might have been because they spoke English as a second language.

The people we spoke with said they thought the service was clean, one of them describing it as, “spotless.” They both told us that dentists and nurses wore protective clothing and that they were offered protective clothing when they had treatment. This showed one of the measures the provider took to prevent and control infection.