We carried out this announced inspection on 23 October 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

InDental practice is in Gateshead, Tyne and Wear and provides NHS and private treatment to adults and children.

InDental practice occupies the ground and first floor of a purpose-built premises; it’s sister practice – InDental Orthodontics – is also on the first floor. There is level access for people who use wheelchairs and those with pushchairs. A lift is also available. Car parking spaces are present near the practice.

The dental team includes the principal dentist, the practice manager, eight associate dentists, 11 dental nurses (including one trainee dental nurse), two decontamination staff, a dental hygienist, two dental therapists and three receptionists. The practice has eight treatment rooms - six on the ground floor and two on the first floor.

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 at InDental practice was the practice manager.

On the day of inspection, we collected 23 CQC comment cards filled in by patients.

During the inspection we spoke with the principal dentist, the practice manager, three associate dentists, four dental nurses, a decontamination operative, a dental therapist and two receptionists.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Wednesday, Thursday and Friday 9am to 5.30pm

Tuesday 9am to 7pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures; these did not reflect published guidance in relation to temperature monitoring of manual decontamination procedures.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available.
• The provider had systems to help them manage risk. These systems were not always effectively monitored.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The provider had staff recruitment procedures.
• 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. The practice had closed-circuit television (CCTV) on the premises. The practice’s CCTV protocols did not follow national guidance.
• The practice provides preventive care and support to patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice leadership could be improved.
• The practice had suitable information governance arrangements.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The monitoring of dental nurses’ training and development could be more robust, for example, by introducing an appraisal system.
• Significant events and incidents were not logged.

We identified an area of notable practice.

• The practice holds a patient forum every six months. Patients are invited to the practice one evening, are provided with refreshments and asked for five positive and five negative aspects of their experience at the dental practice. The results are then analysed and implemented into practice. The Department of Health invited the practice manager to events to discuss the practice forum as an exemplary to other practices. We believe this is notable because it shows the provider values patients’ opinions, welcomes compliments from patients and responds to concerns or recommendations constructively.

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

• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice’s protocols for the use of closed-circuit television taking into account the guidelines published by the Information Commissioner's Office.

• Review the practice’s risk management systems to ensure risk assessments are carried out for all hazardous substances identified by the Control of Substances Hazardous to Health Regulations 2002, and for all other risks identified on-site.
• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review the practice’s protocols for ensuring referrals are monitored adequately.

We found there were arrangements in place for obtaining and acting in accordance with people’s consent to care and treatment. People told us treatment options were discussed with them and their consent was obtained before treatment was carried out. This was supported by clear record keeping.

We asked eight people for their views about the treatment they received. People said they were treated with courtesy and respect and dental staff were able to put them at their ease. Discussion with staff and records confirmed good self care and preventive care was promoted. Arrangements were in place to deal with medical emergencies.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We checked a sample of staff records and found appropriate training had been carried out. This included training on care and treatment practice, promoting equality and diversity and ensuring staff and patient safety.

The provider regularly checked the quality of their service to ensure continual improvement. This included seeking the views of people using the service.