We carried out this announced inspection on 16 July 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

Mydentist - Symmons Way is in Bridgwater and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes seven dentists, two lead dental nurses, three dental nurses, four trainee dental nurses, two dental hygienists, a practice manager, a cleaner and five receptionists. The practice has nine treatment rooms.

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 registered manager at Mydentist - Symmons Way - Bridgwater was the practice manager.

On the day of inspection we collected 40 CQC comment cards filled in by patients and spoke with six other patients.

During the inspection we spoke with five dentists, one lead dental nurses, three dental nurses, four trainee dental nurses, a dental hygienist, a practice manager, three receptionists, an area compliance manager and an area manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday 8am to 7pm

Tuesday, Wednesday and Thursday 8am to 8pm

Friday 8am to 6pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• 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 clinical staff provided patients’ care and treatment in line with current guidelines.
• 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 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 dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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

• Review the practice's policy and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.
• Review the practice's current audit protocols to ensure audits of key aspects of service delivery are undertaken at regular intervals, in particular dental implants, and where applicable learning points are documented and shared with all relevant staff.
• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.

We have previously carried out an announced inspection of this practice on 29 May 2014. After that inspection we received concerns in relation to infection control and staffing. As a result we undertook a focussed inspection to look into those concerns on 15 July 2015. The inspection took place over one day and was carried out by a CQC inspector and a dentist specialist advisor.

This report only covers our findings in relation to those topics. You can read the report from our previous inspections, by selecting the 'all reports' link for East Quay Dental Practice on our website at www.cqc.org.uk.

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.

East Quay Dental Practice is located in Bridgwater, Somerset. They provide general NHS dentistry to adults and children including routine check ups, root canal treatment, extractions, crowns, bridges and oral hygiene. Private treatment was also offered for treatments such as implantology to patients.

This is a large dental practice with nine treatment rooms, two decontamination rooms and a dedicated X-ray room. The practice is purpose built, all treatment rooms are on the ground floor which are fully accessible for patients with poor mobility. The premises also include an accessible toilet and a large waiting area including the reception area.

The staff structure comprises of ten dental practitioners, a hygienist (who works one day a week), two registered dental nurses (one of which was the practice manager) and eight trainee dental nurses. There was also a reception administration team comprising of three to four receptionists per shift.

The practice is open from 8am until 8pm Monday to Thursday and on Friday from 8am until 5:30pm. The practice is also open on Saturday from 9am until 5pm.

The practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons 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 spoke with six patients during the inspection who provided feedback about the service. Patients told us they were seen quickly for urgent treatment, dentists had put them at ease when nervous and patients felt the treatment received was good with staff being helpful and respectful.

Our key findings were:

• The practice had a system in place to assess and monitor the risks associated with infection control. However, there were some improvements the provider should make to ensure these were futher reduced.
• The practice had safe systems in place to assess and monitor patients risks for managing medical emergencies, safe use of equipment and medicine management.
• The practice had arrangements in place to ensure patients received appropriate care and treatment that met their needs and reflected their preferences.
• There were arrangements in place to ensure appropriate support, training, professional development and appraisal were provided to enable staff to carry out the duties they were employed to perform.
• Patients told us they were treated with compassion, respect and empathy and were also involved and fully informed of decisions about their treatment.

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

• Monitor the equipment used to clean and sterilise dental instruments and the process to reduce the risk of legionella to provide assurance that required checks were consistently completed in accordance with current guidelines.

During our inspection we spoke with 12 patients who were complimentary about how the service was provided. One patient said “I’m very pleased with everything here”. Another patient said “nothing to improve on, I would recommend the practice”.

Patients told us they were confident in their dentist’s ability to provide quality dental treatment. One patient said “She’s brilliant. My eldest who has a diagnosis of autism, she’s been really good with him. She reassures him, explains what she’s going to do. He would get very upset otherwise”. Two patients told us they had changed dentists within the practice because they were not happy with the way the treatment was provided from the previous dentist. The practice manager told us they would follow up on the concerns raised and monitor progress.

Patients told us reception staff were helpful and polite when they either visited or phoned the practice. One person said “they are all lovely. They do not panic when it gets very busy”.

During our inspection we spoke with four out of the nine dentists, four out of ten dental nurses and one receptionist. Dental nurses showed a good understanding of infection control to ensure patients were protected from the risk of acquiring an infection.

Patients were seen by staff who had been safely recruited. The provider/practice manager had ensured they were of good character and had the necessary skills and qualifications for their role. However, some recruitment information for dentists was inaccessible because it was held centrally. We have followed this up with the provider.

There were appropriate procedures in place to ensure staff were able to assist people quickly in a medical emergency, if one arose.

The registered manager had appropriate systems in place to monitor and assess the quality of the service.

We carried out this visit to follow up on significant concerns raised at the last inspection. All outcomes reviewed were to check on previous concerns raised and we did not need to speak with people who used the service to reach our judgements for this visit.

We found the provider had made significant improvements since our last visit. There was a new practice manager in post who had helped to implement the changes in the practice.

During our inspection we spoke with five people who used the service. We received mixed opinions of what they thought of the service. One person told us they were considering moving to another dentist. They told us that some of the receptionists could be “snappy” or “short” with them on the phone and face to face. An example of this was when they tried to arrange an urgent appointment and found some of the receptionists to be unhelpful. They did however tell us that the dental staff and the dentist that they saw were always “really nice” and would explain their treatment clearly to them so that they would fully understand any implications.

Another person we spoke with told us “Staff are very pleasant, I have never had a problem with the staff on reception”. Another person said “The practice is very good, staff are generally friendly”.

We asked people how easy it was to book appointments, we received mixed views. One person told us “It is difficult to get hold of staff on the phone”. Another person told us “It was easy to get hold of staff on the phone”.

We asked people whether they were given options of what treatment they would prefer. One person told us they were given an option on whether to have a filling, they decided that they did not want the course of treatment and this was accepted by the dentist.

People we spoke with told us they were aware of the NHS fee bandings and generally knew how much they would need to pay at each visit. One person told us that if they needed a course of treatment they were not informed beforehand how much their treatment would cost. Another person who was visiting the hygienist told us “I know how much I need to pay for the hygienist”.

During our visit we found that ADP Dental Company – Bridgwater were non compliant in relation to supporting staff, infection control, fire safety and protecting vulnerable adults and children.