We carried out this announced inspection on 14 August 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

Hingham Dental Practice is a small, well-established dental practice that provides private treatment to about 2,000 adults and children. The dental team includes one dentist, three nurses, a hygienist and a practice manager. Another, separately registered, dental practice is based at the same location and shares some of the same staff, costs and facilities with this practice.

The practice does not have its own parking facilities, but there is free roadside parking just outside.

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. The registered manager was the dentist.

On the day of inspection, we collected 31 CQC comment cards filled in by patients and spoke with three other patients. We spoke with the dentist, two dental nurses, and the practice manager.

The practice opens on Tuesdays and Fridays from 8.15am to 3pm, Wednesdays 9am till 3.30 pm ,and on Thursdays from 8.30 am to 3.30pm. Reception is open on a Monday between 9am and 4pm.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive view of a caring and professional service.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, apart from paediatric defibrillator pads.

• Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration.

• Staff felt supported by management and the practice proactively sought feedback from staff and patients, which it acted upon.

• The dentist did not follow national guidance in relation to the management of sharps and the use of rubber dams.

• There was no evidence that fixed wire testing had occurred and there was no signage to indicate that oxygen was stored on the premises.

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

• Review electrical fixed wire testing, and signage to indicate oxygen was stored on the premises.

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the management of sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the practice's responsibilities to the needs of people with a disability, including those with hearing difficulties within the requirements of the Equality Act 2010.

The practice contained two registered dental services that used the communal facilities such as the reception and waiting room.

We spoke with two people within the waiting room who were attending appointments at the practice and two people at the reception desk. They told us they felt respected by staff and were fully involved in the decisions about their dental care and treatment. Written information was available for people informing them of the prospective treatment and charges.

People spoken with had no complaints and spoke highly of the dentist and nursing staff that attended to them. One person told us: "There is nothing negative to say, I come for my regular check ups and hardly need any treatment. The staff are kind and explain everything to me." They said: "I was one of the dentist's first patients, I came as an emergency and they sorted me out and I have had extremely good treatment ever since."

The practice had systems in place to monitor and reduce cross infection, safeguard people and investigate complaints. There was the opportunity for people to air their views through the patient satisfaction survey and suggestion box within the waiting room. We saw that the information gathered was used to improve quality of care.