Patients who used the service understood the care and treatment choices available to them. We spoke to three patients who told us they were very pleased with the care they had received from the dentist. They made comments like "I've been coming here for six years and they always explain my treatment and give me a costed plan". We saw that patients were asked to complete and sign a medical history and that this was updated in the computer record as well as being kept on file.

There was no separate decontamination room within this practice and therefore cleaning and sterilization of reusable instruments occurred in the surgery. There were clear procedures followed in an ordered way.

The practice manager explained and showed us the training records that had been updated in infection prevention and we saw that the Department of Health infection prevention audit tool had been completed.

We were told that there were three trained nurses registered with General Dental Council and we saw a detailed training spread sheet which described the continuing professional development of all staff members. We saw that there had been regular staff meetings with signed records of the minutes and that all relevant subject areas had been covered.

We were shown that the provider had performed a patient record audit, x ray quality audit and medical history audit in 2011 and 2012. This showed that patient’s personal records including medical records were accurate and fit for purpose.

We carried out this announced inspection on 01 March 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 not providing well-led care in accordance with the relevant regulations.

Background

Gensing Road Dental Practice is in St Leonards and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs into the reception area only. There are limited car parking spaces near the practice.

The dental team includes one dentist, 2 dental nurses/ receptionists. One of the dental nurses was also the practice manager. The practice has one treatment room.

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 35 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, two dental nurses/ receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 08.30-13.00, Tuesday 12.00-17.30, Wednesday 08.30-17.30 Thursday 08.30-13.00, Friday 08.30-13.00.

Our key findings were:

• The practice appeared clean and partly maintained.
• The provider had some infection control procedures which reflected part of the published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and most life-saving equipment were available.
• The practice had some systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes, however staff were confused about their responsibilities for safeguarding vulnerable adults and children.
• The provider did not have thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with some of the current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing some advice in preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had some effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had some suitable some information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure specified information is available regarding each person employed

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.
• 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 security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• 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.’
• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.
• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities.
• Review the practice's protocol and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.