We carried out this announced inspection on 05 September 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

Lister House Endodontic and Restorative Dental Centre provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. The practice had nearby parking facilities.

The dental team includes six dentists, five dental nurses, three receptionists, (one of which was also a trainee dental nurse) and one practice manager. The practice has four treatment rooms.

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 practice manager was the registered manager.

We received feedback about the service from 19 patients.

During the inspection we spoke with a dentist, two dental nurses, a receptionist 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 Thursday 8.30am - 6.00pm
• Fridays 8.30 – 4.00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance, however some improvements were required.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available, but there were some gaps in the equipment maintained.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough 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 was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and a culture of continuous improvement.
• 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 practice had suitable information governance arrangements.
• The practice carried out conscious sedation for patients who would benefit. We found gaps in staff training and proper maintenance of records related to the procedures. These were brought to the attention of the provider. Following the inspection the provider made the decision to stop carrying out dental procedures using conscious sedation at the practice until the appropriate arrangements were in place.

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

• Review the systems for checking and monitoring equipment taking into account current national guidance and ensure that all equipment is well maintained.
• Review availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s infection control procedures and protocols to take into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
• Review the practice’s protocols for conscious sedation, taking into account guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015

It was not possible to speak to people who use the service as no one was available during the inspection. However, we looked at feedback forms that had been completed in October 2012. These indicated that people were happy with the care and treatment they had received and that the information they had been given was sufficient. One person described the dentist as "the best dentist I have been to".

People were asked to complete a medical history form which the dentist discussed with them. The dentists used photographs and x-rays to explain the treatment required. If a person required sedation then the clinic booked a dedicated anaesthetist who monitored the person until they left the premises. Staff were trained in basic life support and there was emergency equipment available.

There were systems in place to reduce the risk of infection. There were separate decontamination facilities and a dedicated member of staff who was responsible for cleaning reusable instruments. There was a clear process, which staff described to us. There were daily checklists in place which staff were required to record when they had completed and we saw evidence that the manager carried out spot checks. Infection control audits had been undertaken and the water had been tested for Legionella.

There were systems in place to monitor the quality of the service provided, including the clinical practice of the dentists who worked at the clinic.