We carried out this announced inspection on 23 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

Mr M N Devlin – Wolstanton is a dental practice in Newcastle-under-Lyme and provides NHS and private treatment to adults and children. The provider also owns a practice in Crewe and splits his clinical hours between both practices.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in the practice car park.

The dental team includes the principal dentist and a dental nurse who also covers reception. The practice has one treatment room.

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 37 CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with the principal dentist and the dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday, Wednesday and Friday: from 9am to 12.30pm.

Tuesday and Thursday: from 2pm to 5.30pm.

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 with the exception of a child inflating bag and mask. These were ordered within 48 hours of the inspection.
• The practice had not managed all risks to staff and patients. A legionella risk assessment had been completed however the practice did not record the cold-water temperatures as recommended in the risk assessment. Prescriptions were not being managed and controlled in line with current guidance. Dental rubber dams were not being used for root canal treatment.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• There was a long-standing team which had worked together for over 30 years. The provider had thorough staff recruitment procedures which had not been used due to not needing to recruit staff in over 30 years.
• The clinical staff provided patients’ care and treatment mostly in line with current guidelines. Clinical records did not detail the risks and benefits of treatment options discussed with patients.
• 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. However, the dentist was not routinely administering topical fluoride applications in accordance with the Delivering Better Oral Health toolkit.
• The appointment system took account of patients’ needs. Patients could access treatment and emergency care when required.
• 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. Feedback from patients was overwhelmingly positive with patients advising that the team were caring and they always received high quality treatment.
• 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 arising from the undertaking of the regulated activities. In particular risks associated with legionella and prescription handling.
• Review the practice’s protocols for the use of rubber dams for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account the guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

The dentist was supported by a qualified dental nurse who also acted as receptionist.

People who used the service told us they were fully involved in decisions about their care, and the dentist was very good at explaining any treatment. They told us they felt comfortable to ask questions about the treatments available and things were explained clearly to them.

We were present in the treatment room and observed as one person who used the service had treatment.

We saw there were effective systems in place to reduce the risk and spread of infection. People we spoke with told us 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.

We saw that staff were supported in their role and had opportunity to maintain and increase their knowledge and skills.

We found that records were kept up to date and were accurate and secure.