We carried out this announced inspection on 9 January 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; an interpreter was also present during this inspection.

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

Medical-Dent is located in West Bromwich, West Midlands and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. The practice does not have a car park but a local pay and display car park is available near the practice.

The dental team includes six dentists, (one of which has a special interest in orthodontics and one implantologist), two qualified dental nurses, two newly employed trainee dental nurses and two dental support workers. One of these dental nurses mainly works on reception but will work as a dental nurse if required. The practice has two ground floor 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 registered manager at Medical-Dent was the practice owner.

On the day of inspection we collected 24 CQC comment cards filled in by patients and spoke with five other patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, two dental nurses one of whom was working at reception 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 Friday 10am to 9pm, Saturday 9am to 9pm and Sunday 11am to 9pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Not all of the required life-saving equipment was available but this was purchased shortly after this inspection.
• 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. Not all of the dentists were recording basic periodontal scores or grading or justifying the need to take X-rays in patient dental care records.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. 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.

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

• Review the practice’s sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• Review the practice's protocols for completion of dental care records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users

• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a GDC registered and appropriately trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.

We visited the service to follow up the improvements required from our inspection in September 2012, where compliance actions were made in respect of care and welfare, medicine management and the monitoring of the service provided. We spoke with three people using the service, the provider and two staff.

All three people using the service spoken with told us that they were happy with the service provided. One person told us “It is a very good dentist they make sure that all the treatment I have is explained to me’’. Another person told us,” I would not go to another dentist I am very happy’’.

People treatment was planned so they received dental care safety. All medicines were prescribed by a qualified dentist and dispensed by a qualified pharmacy. This meant when people were prescribed medication following treatment this was done safely.

There were systems in place that ensured people using the service were asked their views about the service so the provider could use the information to improve.

During our visit, we spoke with one student dental nurse, the manager who was also the provider and a dentist. We looked at the treatment records for eight people using the service. It was not appropriate to speak to people at the practice on the day we visited. Following our visit we spoke to three people using the service on the telephone so that we could their views about the service provided. People were complimentary about the service. One person told us, "It is very well run, I am impressed with the treatment I have had’’.

All of the people we spoke with told us that their treatments options were explained to them and they had time to consider their options before deciding on the best treatment for them. They told us that appointments were made to suit them and they were seen quickly if they experienced any problems.

People’s medical records were not updated regularly to ensure peoples health and welfare was protected.

The premises were clean and instruments were sterilised to prevent cross infections. People said that the practice was "spotless" and that staff wore protective equipment when treatments were being carried out. We were told that the staff were very friendly and welcoming and that they knew people by name. People said they felt relaxed and staff were very reassuring.

Systems were not in place to monitoring the service, in relation to medicine management, health care checks and feedback from the people using the service.