We carried out this announced inspection on 12 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 providing well-led care in accordance with the relevant regulations.

Background

Hilton Dental Clinic is in the West Bridgford area of Nottingham, and provides mostly private dental treatment and a smaller amount of NHS dental treatment to adults and children.

There is a ramped access to the front door, and level access throughout the practice. This is of benefit for people who use wheelchairs and those with pushchairs. There is roadside car parking in the area around the practice.

The dental team includes three dentists, two qualified dental nurses, one trainee dental nurse, one locum nurse for sedation, two receptionists, and one practice manager. The practice has three treatment rooms, all of which are on the ground floor.

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 46 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, four dental nurses, one receptionist, 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 from 8.30am to 5pm, Tuesday from 9am to 6pm, Wednesday from 8.30am to 4.30pm, Thursday from 8.30am to 5pm and Friday from 8.30am to 5pm. The practice is closed on Saturday and Sunday.

Our key findings were:

• The practice appeared clean and well maintained.

• The provider 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 to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Antibiotics dispensed from the practice were not always labelled correctly.
• 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 provider had 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 suitable information governance arrangements.

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

• Review the practice’s infection control procedures and protocols relating to manual cleaning 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 medicines management and ensure all medicines are dispensed safely and securely with a label containing the practice name and address attached.

We used a number of different methods to help us reach a judgement on this service. These included talking with patients using the service, members of the staff team, observation and looking at records.

We spoke to three patients, one dentist, and two members of practice staff. We also looked at records. These included care plans, records of meetings and information about how the service operated. We looked at information from surveys undertaken by the provider to assess the quality of the service.

Patients we spoke to were involved in their care and treatment options, felt it was delivered in a safe way and that the practice was clean and hygienic.

One patient said, “The staff are very friendly and helpful. They have been wonderful." Another patient said, "I am entirely happy with the treatment I receive here."

We observed members of staff interacting with patients in a courteous, polite and efficient manner.

We saw that the practice had implemented an infection control policy and that staff were encouraged to develop their skills and undertake appropriate training to help deliver safe and effective care to patients.