We carried out this announced inspection on 19 September 2017 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.

We told the NHS England area team that we were inspecting the practice. We did not receive any information of concern from them.

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

MF Dental Littleborough is in converted commercial premises in a high street location in the village of Littleborough. The practice has been part of the Gensmile group of practices since April 2017. They provide NHS and private treatment to adults and children.

There is a small step at the entrance to the premises but people who use wheelchairs and pushchairs can access the practice. On street parking is available near the practice.

The dental team includes four dentists (one of whom is a foundation dentist), seven dental nurses who also cover reception (two of whom are trainees) and four part time dental hygienists. At the time of the inspection, a practice manager was not in post. The clinical team were supported by the practice manager of the nearest Gensmile practice and the registered manager. The practice has five treatment rooms. MF Dental Littleborough is a foundation training practice. Dental foundation training is a post-qualification training period, mainly in general dental practice, which UK graduates need to undertake in order to work in NHS 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 at MF Dental Littleborough was the company operations manager.

On the day of inspection we collected 17 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists including the foundation dentist, two dental nurses, a dental hygienist, the acting practice manager and the registered manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Wednesday 09:00 to 19:00

Tuesday, Thursday and Friday 08:30 to 17:00

Our key findings were:

• The practice was generally clean and well maintained. The cleanliness in some areas could be improved.
• The practice 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 carried out risk assessments to help them manage risk but not all the actions for these had been carried out.
• 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.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The lack of a practice manager had impacted on the leadership of the practice. Staff told us they felt supported by the organisation 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 but this was not always documented.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

• Review cleaning schedules, waste segregation processes and the current legionella risk assessment, to implement the required actions including the monitoring and recording of water temperatures, giving due regard to the 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 staff’s safeguarding training; ensuring all staff are trained to an appropriate level for their role and aware of their responsibilities.

• Review its responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.