We carried out this announced inspection on 15 January 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

Kaye, Rafferty and Associates is in Worksop in north Nottingham and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. There is a pay and display car park a short distance from the practice and this includes spaces for blue badge holders.

The dental team includes seven dentists, one hygiene therapist, six qualified dental nurses, three trainee dental nurses, one designated receptionist and the practice manager. Two of the qualified dental nurses work on reception and the practice manager is a qualified dental nurse. The practice has seven treatment rooms, four of which are on the ground 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 Kaye, Rafferty and Associates is the practice manager.

On the day of inspection, we collected seven CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with two dentists, three dental nurses, two receptionists 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 to Friday: from 8.30am to 5.30pm. The practice is closed 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 most of the staff recruitment information required by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The system for managing prescription pads needed review.
• 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.
• Audits at the practice did not always have action plans, or demonstrate that improvements had been achieved.

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

• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.

• Review the practice’s protocols to ensure audits of radiography and infection prevention and control are undertaken and where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.