We carried out this announced inspection on 21 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

Lowestoft Dental Practice is a small, well-established practice that provides mostly NHS treatment to patients. The dental team includes two dentists, four nurses, a hygienist, a receptionist and practice manager.

The practice opens on Mondays to Fridays from 8.30 am to 5.30 pm. There is level access for people who use wheelchairs and those with pushchairs. On road parking is available near the practice.

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 is the practice manager.

On the day of inspection, we collected 28 CQC comment cards completed by patients, and spoke with another two. We spoke with the practice manager, one dentist, two nurses and the receptionist. We also spoke with the provider’s regional manager. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring, professional and high-quality service. However, some patients told us their appointments had been rescheduled due to a shortage of dentists

• 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.

• Risk assessment was robust and action was taken to protect staff and patients, although recommendations from the fire risk assessment needed to be implemented.

• 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.

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

• 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.

• Patients’ complaints were taken seriously and managed in a professional, timely and empathetic way.

• The practice had effective leadership and a culture of continuous audit and improvement. staff felt involved and worked well as a team.

• The practice asked staff and patients for feedback about the services they provided,

• The practice had experienced difficulties in recruiting dentists and this had adversely affected the availability of appointments for patients and the length of time to complete a course of treatment.

• Not all dentists used rubber dams to protect patients’ airways in line with current best practice.

• The practice followed national guidance for cleaning, sterilising and storing dental instruments, although we noted that the decontamination room was easily accessible to patients and needed to be secured

• The temperature of the fridge in which medicines were stored was monitored weekly. National guidance recommends daily checks to ensure medicines and temperature sensitive materials are kept cool.

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

• 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 storage of dental care products and medicines requiring refrigeration to ensure the fridge temperature is monitored and recorded daily.

• Review the access and security of the decontamination room.

We found that people using the service were involved in making decisions about their treatment, as they were given a wide range of options. One person told us the information they received when they first joined the practice was "...very good." People were given several opportunities to feed back on their experience of the service.

We found that people were given a treatment plan explaining what treatment they had received and what follow on treatment was advised. People signed these treatment plans to state they were happy with the content. People were asked to complete medical history forms before receiving any treatment, to ensure they were safe from harm. Staff had training in first aid, and equipment was available for emergencies. One person we spoke with told us, "The dentist is brilliant, absolutely excellent."

We found that people were protected from the risks of abuse because the provider had taken steps to ensure staff were aware of how to report concerns. Staff had received safeguarding training and all staff members we spoke with displayed a good knowledge of safeguarding procedures. The provider may find it useful to note that the whistleblowing policy didn't include information about whistleblowing outside of the organisation.

We found that there were appropriate procedures in place for controlling the risk of infection.

We found that there was an effective complaints system available, and two complaints had been investigated in line with this.