We carried out this announced inspection on 29 August 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.

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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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 not providing well-led care in accordance with the relevant regulations.

Background

Mr Gehad Philobbos is in Oldham and provides NHS treatment to adults and children.

There are two steps leading to the entrance of the premises. On street parking is available near the practice.

The dental team includes one dentist and two trainee dental nurses who also carry out reception duties. At the time of the inspection, the trainee dental nurses were on leave and temporary staff had been employed to ensure the continuation of services. 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 16 CQC comment cards filled in by patients and spoke with one other patient. Patients were positive about the service.

During the inspection we spoke with the dentist and a temporary staff member. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open two days a week:

Tuesdays and Thursdays 9.30am to 12.45pm and 2pm to 5.30pm

Our key findings were:

• Areas of the practice appeared unclean.
• Infection control procedures were inconsistent and did not reflect published guidance.
• Improvements were needed to the life-saving equipment available. Support staff did not have training or know how to deal with emergencies effectively.
• The practice did not have effective systems to help them manage risk to patients and staff.
• The practice did not have suitable safeguarding processes. Staff did not demonstrate they knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had, but did not follow staff recruitment procedures.
• Patient care and treatment was not consistently provided in line with current guidelines.
• Staff treated patients with dignity and respect. Improvements were required to protect their privacy and personal information.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice did not have effective leadership. There was no evidence of continuous improvement.
• The practice asked patients for feedback about the services they provided.
• The provider had systems to deal with complaints.

We identified regulations the provider was not complying with. They must:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

• Ensure care and treatment is provided in a safe way to patients.

• Ensure patients are protected from abuse and improper treatment.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed, and ensure specified information is available regarding each person employed.

Full details of the regulations the provider is not meeting are at the end of this report.

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

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.

As part of this inspection we obtained the views of seven patients. They gave us positive feedback about the service they received. Their comments included “I’ve been coming here 35 years so it must be good”, “I’m always told what will happen at the next visit” and “Everyone is a pleasure to see; very happy with the service”.

We saw that various assessments were carried out by the dentist during each appointment, and patients were offered lifestyle advice when it was appropriate.

The practice was clean and regular checks were carried out to make sure the risk of infection was minimised. Protective clothing was available for patients and staff.

There was a complaints procedure in place and this was displayed in the waiting area.