We carried out this announced inspection on 5 February 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 providing well-led care in accordance with the relevant regulations.

Background

Great Knightleys Dental Practice is in Basildon, Essex and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs and a lowered area at the reception desk. Car parking spaces are available near the practice.

The dental team includes four dentists, one lead nurse, three dental nurses and two trainee dental nurses, one dental hygienist, one administrator, one receptionist and one practice manager. The practice provides sedation services and is supported by one visiting anaesthetist and one oral surgeon. The practice has four treatment rooms.

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. At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered. The practice was in the process of recruiting to this position.

On the day of inspection, we collected three CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, the lead dental nurse, one receptionist, the practice manager and the provider organisation compliance manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday from 9am to 7 pm.

Tuesday to Friday from 9am to 5 pm.

Saturday from 9am to 1pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice was a referral clinic for procedures under sedation.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs. The practice offered extended hours appointments on Monday evenings and Saturday mornings.
• The practice had effective leadership and culture of continuous improvement.
• 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 staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

When we visited the practice we found that since our last visit in December 2012, a new provider and practice manager had been appointed and considerable improvements had been made to the way services were provided.

A range of information was available in the reception area that informed people of the services they offered. This included costs of treatment and leaflets describing procedures.

Patient records that we viewed contained clear details of treatment plans, including risks, options and benefits. Each contained a medical history form that was updated at each consultation. One person we spoke with said, "I am given an explanation of the treatments and they are always clear and explained well."

We found that the practice followed published guidance around infection control procedures. The cleaning and sterilisation of instruments was carried out correctly and all areas of the practice we visited were clean and tidy.

The provider had effective recruitment procedures in place and records we viewed contained appropriate documentation, including employment references and criminal record checks.

The dentists and dental nurses were supported in the workplace and were undertaking their continuous professional development (CPD), to maintain their skill levels.

The practice carried out a range of audits of the services they provided and sought regular feedback from people using the service and staff in order to identify areas for improvement.