We carried out this announced inspection on 18 February 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

Mike Brown Dental Practice is in Rochdale and provides mainly private treatment to adults and children. The practice has a small NHS contract.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice on the main road and side streets.

The dental team includes two dentists, three dental nurses, one dental hygienist and a practice manager. The practice has three treatment rooms.

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

During the inspection we spoke with two dentists, three dental nurses 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 9am to 8pm, Tuesday and Thursday 9am to 5pm, Wednesday 8am to 5pm and Friday 8am to 1pm.

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. Some items of equipment were missing or time expired in the medical emergency kit.
• The practice had systems to help them manage risk to patients and staff.
• Assurance was required to confirm that the X-ray unit wired to a 13 Amp power outlet conformed to approved electrical safety standards.
• 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; there were inconsistencies in record keeping and knowledge gaps which could be improved.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The process to manage dispensed medicines could be improved.
• The provider was 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 culture of continuous improvement.
• Quality assurance audits could be more effectively managed.
• 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. Improvements could be made to ensure external contacts are accessible to patients.
• The provider had suitable information governance arrangements.

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

• Review the practice's protocols for medicines management and ensure all medicines are stored, logged and dispensed in line with recommended guidance.
• Review the practice's protocols for consistent completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment. In particular: assurance that the X-ray unit wired to a 13 Amp power outlet conformed to approved electrical safety standards.
• Review the practice’s protocols to ensure audits of radiography and dental care records are undertaken at regular intervals to improve the quality of the service and where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.
• Review the practice's complaint handling procedures and ensure information is available to patients on the practice leaflet and that contact details about organisations patients could contact if not satisfied with the way the practice dealt with their concerns are accessible.

Feedback was received from several patients during our visit. Patients confirmed they were informed and consulted with about their treatment. They told us; “It’s an excellent service”, “Treatments have been explained to me and any questions are answered” and the “Dentists and staff are friendly and informative”.

They also commented that; “The staff are kind and considerate”, “They keep in contact by telephone and in writing” and “There are posters to advice people of things”.

Patients also told us that they found the environment to be clean and tidy and in their opinion good hygiene standards were maintained. They also knew what to do if they had any issues or concerns they needed to raised about the practice or the treatment they had received.