We carried out this announced inspection on 9 May 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

Hagley Dental Practice is located in Hagley near Stourbridge and provides predominantly private treatment with a small NHS provision to adults and children.

The practice is on the ground floor of a commercial building which is accessed by a small step. There is a low level assistance bell on the front door should wheelchair users and those with pushchairs require the portable ramp. Car parking spaces, including two for blue badge holders, are available near the practice.

The dental team includes two dentists, six dental nurses (four of whom also work as receptionists), two dental hygienists and a practice manager. 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 50 CQC comment cards filled in by patients and looked at patient satisfaction survey results. This information gave us a positive view of the practice.

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

The practice is open:

Monday: 8am to 12pm and 1pm to 4pm

Tuesday: 8.30am to 1pm and 2pm to 5.30pm

Wednesday: 8.30am to 1pm and 2pm to 5.30pm

Thursday: 9am to 1pm and 2pm to 7pm

Friday: 8am to 2pm

Our key findings were:

• We found that the practice ethos was to provide high quality dental care in a warm, caring and professional manner that staff would extend to their own family members.
• The practice had effective leadership and culture of continuous improvement. Staff told us that they felt supported and enjoyed working at the practice.
• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance, with the exception of completing infection control audits on a six monthly basis. We found there was a nine month gap between the most recent two audits. This was discussed with the practice manager who advised us that these would be completed every six months.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, with the exception of one medicine which was not stored in line with the manufacturer’s guidance. This had caused the medicine to expire; a replacement was immediately ordered by the practice manager and was delivered the day after our inspection.
• The practice had systems to help them manage risk. The practice completed their own legionella risk assessment in August 2016 and had scheduled an external company to complete a legionella risk assessment two days after our inspection, following a recent change in the premises. We found the practice had not completed a five year fixed wire test.
• The practice 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.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs. Patients could access treatment and urgent and emergency care when required.
• The practice asked staff and patients for feedback about the services they provided. Results and improvements from this feedback were shared with patients and staff.
• The practice had received a low number of complaints which were dealt with positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s protocols to ensure audits of infection prevention and control are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice's systems for checking and monitoring equipment taking into account relevant guidance and ensure that all equipment is well maintained. In particular ensuring five yearly fixed wire testing is completed.

During this inspection we spoke with the practice manager, two dentists and one dental nurse. We spoke on the telephone with six people who used the practice.

People felt they were given enough information about their treatment options and felt involved in the choice of treatments they required. One person said: “The dentist wouldn’t do anything without discussing it with me first”.

People that used the practice told us they were very happy with the quality of the information, care and treatment they received. One person we spoke with said: “They are extremely good. It’s the best I have used”.

The practice was clean and hygienic. People we spoke with confirmed that this was their experience too. There were suitable arrangements made for the cleaning, sterilising and storing of instruments so that people were not placed at risk of infection.

We looked at the recruitment process in place. We saw that appropriate checks had not always been carried out before staff commenced employment.

The provider had systems of audits in place to enable them to monitor the quality of the service provided.