We carried out this announced inspection on 20 December 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

My Dentist Upper Northgate Street is in Chester town centre and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs; the practice is fitted with a lift which can take wheelchair users and those with prams to the first floor, where the treatment rooms are fully accessible. There is no car parking immediately outside the practice but a public car park is available near the practice.

The dental team includes five dentists, one visiting dental implantologist, seven dental nurses, two of these being trainees, one dental hygienist, one dental hygiene therapist. The practice is managed on a daily basis by the practice manager who is also the Registered Manager. The clinical team are supported by a treatment co-ordinator and three receptionists. The practice has five 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 My Dentist Upper Northgate Street is the practice manager.

On the day of inspection, we collected 17 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse, the dental hygiene therapist, one receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Tuesday, Thursday and Friday from 9am to 5.30pm, and on Monday from 9am to 7pm. On Wednesday the practice opens from 9am to 6.30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Review the practice's complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by service users.
• 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. For example, to identify a lead Radiation Protection Supervisor.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice. For example, the process for handling medical history updates to be sure these are scanned to electronic patient dental care records.
• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice. For example, that checks performed by locum agencies are confirmed.
• Review the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. For example, by completing works required to address water flow issues on the lower ground floor, that have given rise to a malodourous smell.

We carried out an announced comprehensive inspection on 28 October 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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 - Upper Northgate Street - Chester offers NHS and private dental treatments including preventative advice, dental implants, endodontics, cosmetic dental treatment and orthodontics,

The practice has five surgeries over two floors, a decontamination room connected by a hatch to a instrument bagging and storage area, two waiting areas, an Orthopantomogram (OPT) room, a reception area and accessible patient toilets. All facilities are located over three floors of the premises. There are staff facilities and offices on the third floor of the premises.

There are six dentists, two dental hygienists, seven dental nurses (three of which are trainees), a receptionist and a practice manager.

The practice is open between the hours of 8:30am and 8:30pm; opening and closing hours varying from day to day throughout the week. the practice is also open 9am – 16:30 on a Saturday.

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.

On the day of inspection we received 14 CQC comment cards providing feedback and spoke with six patients. The patients who provided feedback were very positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be very pleasant and helpful. There had been changes to the practice which had been recognised and commented upon and patient said this reassured them and helped them feel more relaxed. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

• The practice had systems in place to assess and manage risks to patients and staff including infection prevention and control, health and safety and the management of medical emergencies.
• The practice appeared clean, hygienic and uncluttered.
• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it. They had good systems in place to work closely and share information with the local safeguarding team.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in accordance with the published guidelines.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• Treatment was well planned and provided in line with current best practice guidelines.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The practice was well-led and staff felt involved and supported and worked well as a team.
• The governance systems were effective.
• The practice sought feedback from staff and patients about the services they provided.
• There were clearly defined leadership roles within the practice and detailed processes for staff training lead by the practice manager.

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

• Review the practice's protocols for completion of dental records giving due regard to guidance provided by the Faculty of General Dental Practice (FGDP) regarding clinical examinations and record keeping.
• Review the accessibility for guidance documents to ensure staff are up to date with current recommendations including the Faculty of General Dental Practice (FGDP), National Institute for Health and Care Excellence (NICE) and guidance from the British Society of Periodontology (BSP).

We carried out an unannounced responsive inspection on 1 August 2016 to ensure the practice was providing safe care in respect of the regulations; we did not inspect other aspects of the service.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations after immediate action was taken as a result of this inspection. Detailed feedback was given to the practice during and following the inspection and this resulted in the practice voluntarily taking the decision to close for a period of time to undertake remedial work. A comprehensive action plan was developed and acted upon within a short timescale to address the concerns.

Background

Mydentist - Upper Northgate Street - Chester is an NHS and private dental practice situated in the centre of Chester close to public transport links. The practice has five treatment rooms, two on the ground floor, a further three surgeries in the basement, a decontamination room, an instrument bagging room and a separate room for the Orthopantomogram (OPT) machine. There is a reception area and two waiting areas. Staff facilities were located on the first floor.

There are seven dentists, two dental hygienists, a dental hygiene therapist, a practice manager, a receptionist and six dental nurses (four of which are trainees).

The practice is open:

Monday - Thursday 09:00 - 18:00

Friday 09:00 - 17:00.

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.

Our key findings were:

• Governance arrangements were in not place for the smooth running of the practice; the practice did not have a structured plan in place to audit quality and safety including infection control.
• Daily and weekly checks on the decontamination equipment were not carried out.
• The dental surgeries were cluttered and visibly dirty.
• Some dental instruments which had been sterilised still had debris on them. Dental instruments were not always bagged in line with HTM 01-05 guidance.
• A medicine in the emergency drug kit was out of date.

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

• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review stocks of medicines and equipment and the system for identifying and disposing of out-of-date stock.
• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understood how to minimise risks associated with the use of and handling of these substances. Review the storage of products identified under (COSHH) Regulations to ensure they are stored securely.
• Review the practice’s infection control procedures and protocols are suitable giving due regard to guidelines 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’.