Patients that we spoke with told us they were informed of their treatment plans one person said,’ The dentist explains everything to me.’’

Patients that we spoke with told us they were happy with their treatment. One person told us,’’ My family have been going for ten years, they are really good I’m happy with the treatment we get.’’

People that we spoke with had no concerns about their safety or poor practice. One person told us, ‘’I feel safe in the surgery, the dentist and staff are very professional.’’

On the day of the visit we found the practice to be bright, clean and well maintained. One person we spoke with told us, ''The surgery is always clean.’’

Staff working were suitably qualified, skilled and experienced. We reviewed staff records showing that staff had been recruited directly from local colleges after completing national qualifications or currently working towards them.

There were no complaints recorded and the people that we spoke with told us they had never needed to complain. One person said, ‘’ I’m always seen on time and I have no complaints about my treatment.’’

We carried out this announced inspection on 29 January 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 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

Mrs H Burns Dental Surgeon is located in a residential area and provides NHS and private dental care for adults and children.

There is level access to facilitate entrance to the practice for people who use wheelchairs and for people with pushchairs. Car parking is available outside the practice.

The dental team includes the principal dentist, two trainee dental nurses and a receptionist/dental nurse. 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.

We received feedback from two people during the inspection about the services provided. The feedback provided was positive.

During the inspection we spoke to the dentist, the dental nurses and the receptionist/dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday 9.00am to 5.30pm.

The practice is closed for lunch between 12.00 and 2.00pm.

Our key findings were:

• The practice had infection control procedures in place. These did not reflect published guidance.
• The provider had safeguarding procedures in place and staff knew their responsibilities for safeguarding adults and children.
• Staff knew how to deal with medical emergencies. Not all the recommended medical emergency equipment was available or working satisfactorily.
• The provider had staff recruitment procedures in place. These were not operating effectively.
• The provider did not take account of current guidelines when assessing and delivering patients’ care and treatment.
• Staff treated patients took care to protect patients’ privacy and personal information.
• The appointment system took account of patients’ needs.
• The provider had a procedure in place for dealing with complaints. This did not contain all the relevant information.
• The practice’s leadership and management structure was unclear. Governance arrangements were ineffective and limited means were in place to encourage improvement.
• The provider had systems in place to manage risk. These were not operating effectively.
• Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.

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 all premises and equipment used by the service provider is fit for use.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

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

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice’s system for recording, investigating and reviewing incidents and significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice's complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users. In particular, ensure sufficient information, including contact details for NHS England and the Dental Complaints Service is available for patients.