We carried out this announced inspection on 16 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

Horn Mews Dental Practice is in Braintree, Essex and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in local car parks near the practice.

The dental team includes two dentists, three dental nurses (including one trainee dental nurse) and one receptionist. 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 17 CQC comment cards filled in by patients.

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

The practice is open: from 9am to 5pm Monday to Friday.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of a paediatric ambubag. Fridge temperatures were not monitored. Following the inspection the provider took immediate action to replace equipment and put systems in place to monitor fridge temperatures.
• The practice appeared clean and well maintained.
• The practice had effective systems to help ensure patient safety. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control. We found that not all of the clinicians were using rubber dams to protect patients’ airways’.
• The provider had some risk assessments to minimise the risk that can be caused from substances that are hazardous to health. There was no evidence to confirm these had been regularly reviewed to confirm they were still appropriate and there were no data safety sheets available for products used by the practice cleaner.
• A sharps risk assessment had been undertaken. Although this was limited in its detail and there was no evidence to confirm this was updated annually.
• 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.
• Not all staff had annual appraisals.
• The appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided. Staff felt involved and worked well as a team.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.

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

During our inspection on 01 May 2013, we spoke with two patients. They told us staff treated them respectfully and were helpful. One patient told us: “We are a very nervous family when it comes to going to the dentist but we love it here. The dentist is lovely, that’s why we come here.”

We saw that the practice had two separate decontamination rooms and that the relevant guidance for cleaning instruments was followed. However neither room had a dedicated hand washing sink. We found no evidence that staff had received regular supervisions and appraisals, or that appropriate pre employment checks had been carried out.

The patients we spoke with were happy with the practice and did not have any concerns or issues about the care they received. The staff we spoke with told us they enjoyed working at the practice and felt they were supported by the manager. We saw evidence that the practice had complaints policies and procedures in place.