We carried out this announced responsive inspection on 7 December 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 Cheshire and Merseyside area team that we were inspecting the practice. We did not receive any information of concern from them.

We reviewed the practice against two of the five questions we ask about services: is the service safe and well-led?

These questions formed the framework for the areas we looked 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 well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Hale Road Dental Practice is located in a residential suburb of Liverpool and provides dental care and treatment to adults and children on an NHS and privately funded basis.

The provider has installed a ramp to facilitate access to the practice for wheelchair users. The practice has 3 treatment rooms. Car parking is available near the practice.

The dental team includes a principal dentist, four associate dentists, five dental nurses and a receptionist. The team is supported by a practice manager, who is also a registered dental nurse

The practice is owned by a company and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Hale Road Dental Practice is the principal dentist.

During the inspection we spoke to the principal dentist, dental nurses and the practice manager. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday to Wednesday 8.00am to 5.30pm

Thursday 9.00am to 5.30pm

Friday 9.00am to 4.00pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures in place.
• Staff provided patients’ care and treatment in line with current guidelines.
• The practice had procedures in place for dealing with whistleblowing concerns and complaints.
• Staff took care to protect patients’ privacy and personal information.
• The practice had a leadership structure. Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The practice had systems in place to help them manage risk. Risk assessments were not in place for two clinical staff in relation to the effectiveness of the Hepatitis B vaccination.

There were areas where the provider could make improvements and should:

• Review the practice’s system to ensure it is effective in assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities, specifically in relation to staff immunity to Hepatitis B.

We carried out an announced comprehensive inspection on 18 August 2016 to ask the practice the following key questions; are services safe, effective, caring, responsive and well-led?

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

Hale Road Dental Practice is located in a residential suburb of Liverpool and comprises a reception and waiting room, and two treatment rooms on the ground floor, and a further waiting room, treatment room, offices, storage, and staff rooms on the upper floors. Parking is available on nearby streets. The practice is accessible to patients with disabilities, impaired mobility, and to wheelchair users.

The practice provides general dental treatment to patients on an NHS or privately funded basis. The practice is open Monday to Wednesday, 8.00am to 5.30pm, Thursday 9.00am to 5.30pm, and Friday 9.00am to 4.00pm. The practice is staffed by a principal dentist, two associate dentists, a practice manager, who is also a dental nurse, and seven dental nurses, four of whom are trainees.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We received feedback from 31 people during the inspection about the services provided. Patients were extremely positive about all aspects of the dental service. Patients commented that they found the practice excellent and well organised, and that staff were professional, friendly, and caring. They said they were always given good explanations about dental treatment, and that the dentists listened to them and were thorough. Patients commented that the practice created a lovely environment and was clean and comfortable. One patient commented that the care and respect shown by the dentists and staff could not be bettered.

Our key findings were:

• The practice had procedures in place to record and analyse significant events and incidents.
• Staff had received safeguarding training, and knew the process to follow to raise concerns.
• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies, and emergency medicines and equipment were available.
• The premises and equipment were clean, secure and well maintained.
• Staff followed current infection control guidelines for decontaminating and sterilising equipment.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current legislation, standards, and guidance.
• Patients received information about their care, proposed treatment, costs, benefits, and risks, and were involved in making decisions about it.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• Patients were treated with kindness, dignity, and respect, and their confidentiality was maintained.
• The appointment system met the needs of patients, and emergency appointments were available.
• Services were planned and delivered to meet the needs of patients, and reasonable adjustments were made to enable patients to receive their care and treatment.
• The practice gathered the views of patients and took these views into account.
• Staff were supervised, felt involved, and worked as a team.
• Governance arrangements were in place for the smooth running of the practice and for the delivery of high quality person centred care.

There were areas where the provider could make improvements and should:

• Review the guidelines issued by the Department of Health in the 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, specifically in relation to the security of the decontamination room.