We carried out an announced comprehensive inspection on 11 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 not providing well-led care in accordance with the relevant regulations.

Background

Highfields Dental Practice is located in a residential suburb close to the centre of Crewe. It comprises a reception and waiting room and two treatment rooms on the ground floor and a treatment room, a further waiting 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 opening times are Monday to Friday 8.30am to 5.30pm. The practice is staffed by a principal dentist / practice manager, two locum dentists, a dental nurse and four receptionists.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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.

The building is shared with another separately registered dental service provider.

We received feedback from four people during the inspection about the services provided. Patients commented that the staff were friendly and helpful and that the service was good.

Our key findings were:

• There were sufficient numbers of suitably qualified and skilled staff to meet the needs of patients.
• Emergency medicines and equipment were available.
• The premises and equipment were clean and secure.
• Decontamination procedures were in place and staff followed these.
• 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.
• Patients were treated with 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.
• Staff felt involved and worked as a team.
• Governance arrangements and some systems and processes were in place for the smooth running of the practice however these were not all operating effectively.
• The practice had procedures in place to record and analyse significant events and incidents; however significant events were not being recorded.
• Staff had not received safeguarding training but knew the process to follow to raise concerns.
• Staff were not provided with opportunities for training and learning or supported to meet the requirements of their professional regulator.
• The practice gathered the views of patients but we did not see evidence of patient feedback being taken into account.

We identified regulations that were not being met and the provider must:

• Ensure the practice has suitable arrangements in place for receiving and responding to safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System, and other relevant bodies such as Public Health England.
• Ensure the practice’s system for the recording, investigating and learning from incidents and significant events is robust with a view to preventing further occurrences.
• Ensure an effective system is established to review the training, learning and development needs of individual staff.
• Ensure staff are up to date with their mandatory training and their continuing professional development and are supported to meet the requirements of their professional regulator.
• Ensure all audits have documented learning points and resulting improvements can be demonstrated as part of the audit process.

You can see full details of the regulation not being met at the end of this report.

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

• Review the practice’s infection control procedures and protocols, specifically in relation to cleaning equipment storage, to ensure they are suitable, having 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 sharps procedures having due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice’s procedures to establish whether the practice is in compliance with its legal obligations under the Ionising Radiations Regulations 1999 and Ionising Radiation (Medical Exposure) Regulations 2000.
• Review the communication processes to ensure effective communication and forward planning are enabled with the other provider who shares this location. This should include, for example, the implementation of an agreement or protocol in relation to shared services.

When we carried out our inspection we spoke to three patients of the provider. They told us that they gave consent to treatment and that the dentist discussed treatment with them; however one patient felt “rushed”. Another said “the options are explored” and that “benefits and risks were explained”.

No-one raised serious concerns about the service but one person said that the dentist seemed “a bit rushed”. Another patient told us that the treatment was “very good, excellent”. Asked about concerns they said they had “none whatsoever”.

We found that the premises including the surgeries were clean and that the practice had appropriate procedures for infection prevention and control. Reusable instruments were decontaminated properly in suitable decontamination rooms and both staff and patients used personal protective equipment when appropriate.

Equipment including x-ray machines was serviced properly.

There was an effective complaints process and the provider a variety of other methods to collect comments from their patients.

We carried out this unannounced inspection on 14 February 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.

We told the NHS England Cheshire and Merseyside area team that we were inspecting the practice. They provided information which we took into account.

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 not 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

Highfields Dental Practice is close to the centre of Crewe and provides dental care and treatment to adults and children on a privately funded basis.

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

The dental team includes one locum dentist, one dental hygiene therapist, three dental nurses, two of whom are trainees, and one receptionist. The provider manages the practice.

The practice is owned by an individual. 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.

The premises is shared with another separately registered dental service provider.

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

The practice is open:

Monday to Friday 8.30am to 5.30pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• The practice had safeguarding processes in place and staff knew their responsibilities for safeguarding adults and children.
• The practice had a procedure in place for dealing with complaints.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
• The practice asked patients and staff for feedback about the services they provided.
• Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available with the exception of a child sized self-inflating resuscitation bag.
• The practice had systems in place to help them manage risk, but had not put in place all reasonably practicable measures to reduce these risks.
• The practice had staff recruitment procedures in place. Some pre-employment checks had not been carried out.
• Staff had limited access to supervision and support.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the practice’s whistleblowing policy to ensure that details of external organisations are included should staff wish to raise concerns.
• Review the availability of equipment to manage medical emergencies taking into account the guidance issued by the Resuscitation Council (UK), and the General Dental Council.
• Review the practice’s protocols in relation to the use of closed circuit television to ensure staff and patients are fully informed as to its purpose and their right to access footage, and ensure registration with the Information Commissioner’s Office is current.
• Review the availability of an interpreter service for patients who do not speak English as their first language.