We carried out this announced inspection on 22 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

J G Plummer and Associates is a family run business who own and manage 11 practices in the Norfolk and Suffolk area. The Lowestoft branch is a mixed dental practice providing mostly NHS treatments to about 70,000 adults and children. They also provided a specialist orthodontic services and implants. The dental team includes 17 dentists, 30 nurses, one hygienist and a range of administrative staff. There are 12 surgeries and the practice opens from 8.30am to 5.30 pm Monday to Friday.

There is level access for people who use wheelchairs and those with pushchairs.

As a condition of registration, the practice 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 is one of the company’s partners, who is also a dentist at the practice.

On the day of inspection, we collected 10 CQC comment cards filled in by patients and spoke with four other patients. We spoke with four dentists, two dental nurses, reception staff and the practice manager. We also spoke with the provider’s clinical and administrative leads, and one of the partners.

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

Our key findings were:

• 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, and responding to medical emergencies.

• Patients received their care and treatment from well supported staff, who enjoyed their work.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• The practice provided good preventive care and supported patients to ensure better oral health.

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

• The practice had effective leadership and a culture of continuous audit and improvement.

• The practice asked staff and patients for feedback about the services they provided. Staff felt involved and supported, and worked well as a team.

• Autoclaves were not validated adequately to ensure they were operating correctly.

• Patients’ paper dental care records were not stored in line with current guidance.

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

• Review the storage of medicines requiring refrigeration to ensure the fridge temperature is monitored daily, and action is taken if it falls outside recommended temperature guidelines.

• Review the practice’s testing protocols for equipment used for cleaning dental instruments taking into account guidelines issued by the Department of Health - 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 storage arrangements for patients’ paper dental care records to ensure they are held securely.