We carried out this announced inspection on 8 May 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

MacFarlane Dental Practice, Whalley is in the village of Whalley, near Clitheroe and provides NHS treatment to children and private treatment to adults and children. It also provides orthodontic treatment.

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

The dental team includes four dentists, seven dental nurses, three dental hygienists, one receptionist and a practice manager. The practice has three treatment rooms.

The practice is owned by a partnership 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 at MacFarlane Dental Practice, Whalley, is the principal dentist.

On the day of inspection, we collected 36 CQC comment cards filled in by patients. All feedback provided was highly positive.

During the inspection we spoke with one dentist, two dental nurses, the 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, Tuesday and Thursday from 8am to 1pm, and from 1.30pm to 5.30pm. On Wednesday and Friday, the practice opens from 8.45am to 1pm and from 1.30pm to 5.30pm on Thursday, and from 1.30pm to 4.30pm on Friday.

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 practice had systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider 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.
• 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 a 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 governance arrangements for issue of NHS prescriptions.
• Review the practice protocols or completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice. Specifically, the recording of basic periodontal examinations.

We carried out an announced comprehensive inspection on 1 November 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

Macfarlane Dental Practice was established in 1991. The practice provides both specialist and general NHS treatment for children, and for adults this is on a private basis. Three dentists are employed and each has their own area of specialism, including orthodontics, cosmetic dentistry and implants. The dentists are supported by seven dental nurses, a dental hygienist, a practice manager and receptionist. The practice is located on the main street in the centre of Whalley. The practice is located over three floors in a grade 2 listed building. There is a surgery on the ground floor for patients unable to use the stairs. Parking is available close by.

The practice is open 8:00am to 5:30pm Monday and Tuesday, 8:45am to 5:30pm on Wednesday, 8:00am to 6:00pm on Thursday and 9:00am to 4:30pm on Friday.

The practice is registered with the Care Quality Commission (CQC) as a partnership. Like registered providers, the partners 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.

Our key findings were

• The practice manager had ensured effective and well organised governance arrangements were in place at the practice.
• Staff said they were well supported and the team worked well together.
• Staff demonstrated a patient-centred approach in the way they worked and showed commitment to providing a quality service to their patients.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• The practice had systems and resources in place to assess and manage risks to patients and staff including, infection prevention and control, health and safety and the management of medical emergencies.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• The practice was visibly clean, clutter-free and well maintained.
• Patients’ needs were assessed and care was planned and delivered in line with current professional guidelines
• The practice had effective safeguarding processes in place and staff understood their responsibilities for safeguarding vulnerable adults and children.
• Staff reported incidents and kept records of these that the practice used for shared learning.
• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).
• Feedback from patients gave us a completely positive picture of a friendly, professional service.
• The practice took into account any comments, concerns or complaints from patients and used these to help them improve the practice.
• All complaints were dealt with in an open and transparent way by the practice manager if a mistake had been made.

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

• Review the airflow ventilation in the decontamination room giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the practice policy to clarify when notifications to CQC should be instigated.

People told us they were very satisfied with the care and treatment provided at Macfarlane Dental Practice. One person said, “I think they are outstanding, everything is carefully explained and they treat me with respect” and another person commented, “I cannot speak highly enough of them, in my view they couldn’t be better”.

People spoken with confirmed they were involved in their treatment plan and said they had discussed various treatment options with their dentist. People also said they were treated with respect and their queries were answered in a sensitive and understanding manner.

Suitable arrangements were in place for the protection of children and safeguarding vulnerable adults.

People were treated in a clean environment and comprehensive arrangements were in place for the safe decontamination of reusable instruments and equipment.

People were aware how they could raise any concerns and suitable arrangements were in place to respond to any complaints. None of the people spoken with had any concerns about the service.