We carried out this announced inspection on 01 June 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 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

The practice is in Rushden, a town in the county of Northamptonshire. It provides mostly NHS as well as some private treatment to adults and children. At the time of our inspection, the practice was accepting new NHS patient registrations.

There is a slight raised step to gain access to the premises. People who use wheelchairs and those with pushchairs are provided with assistance by staff if this is required. There is some limited car parking at the rear of the premises for staff and patient use. Public car parking facilities are also available within close distance to the practice. This includes parking for blue badge holders.

The dental team includes one dentist, one dental therapist/hygienist, three dental nurses, two trainee dental nurses and two receptionists. The practice has three treatment rooms; one of which is on the ground floor.

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 72 CQC comment cards filled in by patients.

During the inspection we spoke with the dentist, the dental therapist/hygienist, two dental nurses, one trainee dental nurse and the two receptionists. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Friday from 8.30am to 5pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Most appropriate medicines and life-saving equipment were available. We noted an exception as buccal midazolam and a bronchodilator spacer were not available on the day. They were obtained shortly after our inspection took place.
• The practice had systems to help them manage risk. We noted some areas where the systems could be strengthened. For example, the processes for reporting, managing and learning from accidents and other incidents.
• The practice had mostly suitable safeguarding processes, although not all staff had undertaken training to the required level to manage safeguarding issues.
• The practice had thorough staff recruitment procedures.
• The clinical staff mostly provided patients’ care and treatment in line with current guidelines. We noted some areas for improvement in dental record keeping and the type of X-rays taken.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and was in the process of developing a culture of continuous improvement.
• 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 had systems to address complaints, although they had not received any within the previous 12 months.
• The practice staff had suitable information governance arrangements.

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

• Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults. The practice should also review the frequency of the training completed.
• Review the practice’s protocols for the selection criteria of radiographs taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the need to effectively record caries, periodontal and cancer risks within patients’ dental care records, taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice’s system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

People told us that they were asked for their consent before any treatment commenced. The dentist told us about how treatment options were described including the use of real time television images that were used to support the information given to people.

People who used the service told us that they felt safe when they received care and treatment. A person we spoke with said, ‘’ When I go for my treatment I am always offered a clean apron and eye goggles.'' Another person said, ‘’The dentist and the nurse always wear gloves goggles and masks.’’

There were effective systems in place to reduce the risk and spread of infection. We reviewed the infection prevention and decontamination policies and found them to be up to date and comprehensive with responsibilities clearly defined.

We found there were effective recruitment and selection processes in place.

The provider had an effective quality assurance system to monitor the quality of service provided.