We carried out this announced inspection on 11 December 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

Low Fell Caring dental practice is in Gateshead, Tyne and Wear and provides predominantly NHS treatment to adults and children. The practice has four treatment rooms. Car parking is available within the premises and on the side-streets near the practice. Step-free access for wheelchair users or people with pushchairs is available.

The dental team consists of the registered provider, practice manager, assisting practice manager, four dentists, two qualified dental nurses (one of whom is also the receptionist) and five trainee dental nurses. The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection, we collected one CQC comment card filled in by patients.

During the inspection we spoke with the registered provider, four associate dentists, seven dental nurses and the practice managers. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Tuesday and Thursday 8am to 6pm

Wednesday and Friday 8am to 5.30pm

Saturday 9am to 5pm

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 Glucagon (medicine used for diabetic emergencies) was not stored in accordance with manufacturer’s recommendations.
• The practice had systems to help them manage risk to patients and staff. Risk assessments were not specific to a member of staff where necessary.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures. The process for undertaking Disclosure and Barring Service checks or an adequate risk assessment for not doing so needed to be reviewed.
• 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. A closed-circuit television system (CCTV) was in operation; there was no policy or data protection impact assessment in place.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• 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.

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

• Review the practice’s systems for assessing, monitoring and mitigating the various risks within the practice. In particular, risk assessments should be undertaken in circumstances where a DBS check is not carried out, and should be carried out specific to the employee for those who cannot demonstrate immunity to the Hepatitis B vaccination.
• 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 for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.
• Review the storage of Glucagon medicine in the practice taking into account the guidelines issued by the manufacturer.
• Review the practice’s protocols for referrals, to ensure they are monitored adequately and are dealt with in a timely manner.

We carried out an announced comprehensive inspection on 08 December 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 providing well-led care in accordance with the relevant regulations.

Background

Low Fell Caring dental practice is located in Gateshead, Tyne and Wear and provides predominantly NHS treatment to patients of all ages.

There are four treatment rooms spread over two floors, a dedicated decontamination room for sterilising dental instruments, two waiting rooms, a staff kitchen and general office. Car parking is available within the premises and on the side-streets near the practice. Access for wheelchair users or pushchairs is possible via the step-free footpath and driveway at the entrance of the premises.

The practice is open:

Monday, Tuesday and Thursday 0800-1800

Wednesday 0800-1730

Friday 0800-1730

Saturday 0900-1700

The dental team is comprised of the registered provider, practice manger, assisting practice manager, five dentists, three qualified dental nurses (one of whom is also the receptionist) and five trainee dental nurses.

The practice owner is registered with the Care Quality Commission (CQC) as an individual. 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.

We reviewed 13 CQC comment cards on the day of our visit; patients were very positive about the staff and standard of care provided by the practice. Patients commented they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.

Our key findings were:

• Staff were very friendly, caring and enthusiastic.
• The practice was visibly clean and an infection prevention and control policy was in place.
• We saw sterilisation procedures followed recommended guidance.
• The practice had systems for recording incidents and accidents.
• Dental professionals provided treatment in accordance with current professional guidelines.
• Patient feedback was regularly sought and reflected upon.
• Patients could access urgent care when required.
• Dental professionals were maintaining their continued professional development (CPD) in accordance with their professional registration.
• Complaints were dealt with in an efficient and positive manner.
• Staff received annual medical emergency training.
• Equipment for dealing with medical emergencies reflected guidance from the resuscitation council.
• Staff were aware on how to escalate safeguarding issues for children and adults should the need arise. Contact details were available within their safeguarding policy.
• The practice managers received safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA). These were distributed to other dentists and shared amongst all staff within the practice.
• The practice was actively involved in training programmes such as vocational training for qualified dentists and teaching student dental nurses.
• Staff meetings were infrequent.
• Dentists were not using rubber dam for root canal treatment.
• Recruitment procedures were not consistent.
• Dental staff turnover was high.
• Staff were not fully supported in their roles.

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

• Review the practice's recruitment policy and procedures to ensure recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and to ensure necessary employment checks are in place for all staff. This includes ensuring the required specified information in respect of persons employed by the practice is held.
• Review the practice’s procedures for undertaking regular staff satisfaction surveys and staff meetings to help improve the quality of service and review staff turnover.
• Review the practice’s lone working risk assessment to ensure it is specific to the requirements of a particular lone working employee.
• Review the requirements of the Equality Act 2010 and fully assess the barriers which may prevent some people from using their services, for example by undertaking a disability access audit.
• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review the storage methods for medical emergency drugs including Glucagon (used for diabetic emergencies) to ensure manufacturer’s guidance is followed.
• Review the practice’s audit protocols to document learning points, share with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.

Patients' treatment needs were carefully assessed before any treatment was planned or delivered. Their medical history was taken into account, in case it might affect their current treatment. One patient told us she was very happy with her care and treatment, and said, “Overall, they are very, very good.”

Patients were asked to give their verbal and written consent to any treatment they required. Where people were unable to give such consent the practice was careful to respect their rights.

The practice and the surgeries were kept clean and hygienic and proper procedures were in place to prevent the spread of infection.

Dentists and dental nurses in the practice were properly trained. They were encouraged and supported to keep their knowledge and skills up to date at all times.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.