We carried out this announced inspection on 9 May 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 and Healthwatch that we were inspecting the practice. They did not have any relevant information to share with us regarding this dental practice.

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 dental practice is located in premises in the centre of the Meadows area of Nottingham. The practice provides mainly NHS treatment (99%) to patients of all ages.

There is level access for patients to the front door. The practice has three treatment rooms, two upstairs and one downstairs. At the time of the inspection the ground floor treatment room was not in use. Therefore, patients who used a wheelchair or who could not manage the stairs were referred to a sister practice in the Clifton area of Nottingham which had level access. There are limited car parking spaces in the area and the tram stop is a short walk from the practice.

The dental team includes one dentist; one qualified dental nurse; one practice manager; one receptionist and one trainee dental nurse.

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 practice has two registered managers, one being the practice manager.

On the day of inspection we collected three CQC comment cards filled in by patients. On this occasion we did not speak with any patients. This information gave us a positive view of the practice.

During the inspection we spoke with the dentist, two 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 to Thursday: 9 am to 5 pm and Friday: 9 am to 12:30 pm.

Our key findings were:

• The practice was clean and well maintained.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The infection control procedures did not follow published guidance.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Although we noted that rubber dams were not always used when clinically indicated.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff training for the completion of dental care records needed to be reviewed.
• The appointment system met patients’ needs.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidance issued by the British Endodontic Society.

• Review the practice’s infection control procedures and protocols to take into account guidance 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 practice's protocols for completion of dental records taking into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

• Review the systems for checking and monitoring equipment taking into account current national guidance and review systems to ensure that all equipment and materials are within their use-by-date.

We found staff wore appropriate personal protective equipment when delivering treatment. They had a good understanding of why they should keep all areas clean.

We found the surgery that was being used for treatment was clean and tidy.

There were systems in place to ensure the decontamination process was adhered to.

We used a number of different methods to help us reach a judgement on this service. These included talking with patients using the service, members of the staff team, observation and looking at records.

We spoke to three patients, two dentists, three members of practice staff and the practice manager. We also looked at records. These included care plans, records of meetings and information about how the service operated. We looked at information from surveys undertaken by the provider to assess the quality of the service.

Patients we spoke to were involved in their care and treatment options and felt it was delivered in a safe way.

One patient said, “I was told if I was experiencing any problems to come back and have things checked.” We asked another patient about cleanliness and infection control and one patient said, "My dentist wore gloves but did not wear a mask during my consultation."

We observed members of staff interacting with patients in a courteous, polite and efficient manner. However we did observe one dentist examining a patient without wearing a protective mask.

We saw that the practice had an infection control policy, however it had not been effectively implemented and the consultation room on the ground floor was not adequately stocked and prepared to provide effective treatment.

Staff were encouraged to develop their skills and undertake appropriate training to help deliver safe and effective care to patients.