We carried out an announced comprehensive inspection on 12 September 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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 not providing well-led care in accordance with the relevant regulations.

Background

Kings Heath Dental Practice has two dentists who work full time; one of whom is the principal dentist, one part time dental therapist, a part time dental hygienist, one qualified dental nurse who is registered with the General Dental Council (GDC), a recently qualified dental nurse awaiting registration with the GDC, a receptionist and a practice manager. The practice’s opening hours are 8am to 5pm on Monday and Wednesday, 8am to 6pm Tuesday and Thursday and 9am to 5pm on a Friday. The practice closed between the hours of 1pm to 2pm each day during lunchtime.

Kings Heath Dental Practice provides NHS and private dental treatment for adults and children. The practice has three dental treatment rooms on the ground floor. There is a separate decontamination room for cleaning, sterilising and packing dental instruments. There was also a reception and waiting area.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. Registered persons 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 principal dentist was present during this inspection.

Before the inspection we sent Care Quality Commission comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received feedback from 34 patients who provided an overwhelmingly positive view of the services the practice provides. All of the patients commented that the quality of care was good.

Our key findings were

• Systems were in place for the recording and learning from significant events and accidents.
• Patients were treated with dignity and respect.
• The practice was visibly clean and well maintained.
• Infection control procedures were in place with infection prevention and control audits being undertaken on a six monthly basis. Staff had access to personal protective equipment such as gloves and aprons.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• The provider had emergency medicines in line with the British National Formulary (BNF) guidance for medical emergencies in dental practice.
• The provider did not have an automated defibrillator. A risk assessment had been developed and an agreement was in place with a nearby practice to use their equipment however, this was within a 10 minute walk of the practice.
• Staff had been trained to deal with medical emergencies although update training was overdue.
• The appointment system met the needs of patients and waiting times were kept to a minimum.

We identified regulations that were not being met and the provider must:

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities. This should include ensuring appropriate signage is on doors where X-ray machines are located.

• Ensure that systems and processes are implemented to safeguard patients from abuse.

• Ensure that basic life support training is completed, equipment and medicines are available to manage medical emergencies and these are checked in line with the guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

There were areas where the provider could make improvements and should:

• Review the practice’s RIDDOR policy to ensure correct information regarding reporting information under RIDDOR regulations is recorded.
• Review the practice’s procedures regarding Duty of Candour and ensure information is available to patients at the practice.
• Review the current staffing arrangements to ensure all dental staff, including hygienists are suitably supported by a trained member of the dental team when treating patients in a dental setting.
• Review the practice’s systems and documentation regarding fire drills and ensure that details of all staff in attendance and the date and time of the drill are recorded.

• Review the practice’s responsibilities to the needs of people with a disability and the requirements of the Equality Act 2010 and ensure systems are in place to assist those patients with hearing difficulties.

We carried out this inspection to check on the care and welfare of people using this service. Our inspection was discussed and arranged two days in advance. This was to ensure that we had time to see and speak to staff working at the practice, as well as people registered with the service.

The practice had a current contract with the NHS to provide NHS dental care to people. People could choose to pay for private treatment which was outside the agreed treatments of the NHS, or through a dental payment plan.

People told us that they had been fully involved with the staff about the treatments available to them and the costs involved. Consent was sought at the outset of treatment and information was provided to people about treatment options. People told us they felt that they were treated with respect and dignity.

Treatment could be arranged at a convenient time, and people told us they did not experience any lengthy delays. Everyone we spoke with told us they were happy with the service and would recommend the practice to family and friends.

There were effective systems in place to reduce the risk and spread of infection. People we spoke with said everything always looked clean and they were satisfied with the standards of cleanliness. We saw there were good standards of hygiene and infection control practices in place.