We carried out this announced inspection on 15 May 2017 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 that we were inspecting the practice. They did not provide any information.

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

Fraser Dental Practice is in Edgbaston, Birmingham and provides NHS and private treatment to patients of all ages. There are stairs to gain access to the front of the building. However, a portable ramp could be provided to gain access to a private entrance of the building for people who use wheelchairs and pushchairs. Car parking spaces were available at the front of the practice.

The practice is open: Monday, Wednesday and Thursday from 8.30am to 5.30pm, Tuesday 8am to 5.30pm, Friday 8am to 4.30pm and on designated Saturdays from 9.30am to 1pm. The practice is closed to patients for an hour most lunchtimes although telephones will be answered during this time.

The dental team includes two dentists, two dental nurses, one dental hygienist therapist, a practice manager and one patient co-ordinator/receptionist who is also a qualified dental nurse. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 33 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two dental nurses, the patient co-ordinator/receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• The practice was clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Patients were involved in their care and treatment planning so they could make informed decisions.
• 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. However the practice had relied on the pre-employment information obtained by an agency for two staff recently employed. The practice had not obtained a copy of this information.
• Not all of the records seen demonstrated that all clinical staff provided patients’ care and treatment in line with current guidelines. However the practice took action to address this following our inspection.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. 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.
• Information we obtained from 33 Care Quality Commission cards provided positive feedback.

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 giving due regard to guidelines issued by the British Endodontic Society.
• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Review the practice’s arrangements for people with hearing difficulties.
• Ensure audit protocols to document learning points are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.

Our visit was discussed and arranged with the practice two days in advance. This was to ensure that we had time to see and speak to staff working at the practice, as well as people registered with the practice. During the inspection we spoke with the dentist (who was also the registered provider) and two dental nurses. After our inspection visit, we spoke by telephone with seven people who were registered with the practice to ask them about their experiences of the service.

People that used the practice told us that they were happy with the quality of treatment received. They felt they were given enough information about their treatment options and were able to ask all the questions they wanted to. Their comments included, “Excellent been going a number of years”, “Fantastic practice, really good dentist” and “He (the dentist) discussed the options and future care.”

People who were very nervous about going to the dentist told us that the staff were friendly and patient with them. Staff reassured them throughout their treatment, putting them at ease.

People told us that the practice was clean and tidy and that they had no concerns about hygiene. We found that the provider had effective infection control procedures in place. This meant the risk of infection for people using the service was minimised.

There were systems in place that ensured people using the service were asked their views about the service so the provider could use the information to improve.