We carried out this announced inspection on 5 February 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 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 not providing well-led care in accordance with the relevant regulations.

Background

Newnham Dental Practice is a well-established practice based in Ely that provides private treatment to about 1,000 patients. It has two treatment rooms. The dental team includes one dentist, three hygienists and three dental nurses. An orthodontic and endodontic specialist visit regularly to provide additional treatment to patients.

There is ramp access for people who use wheelchairs and those with pushchairs. There is no on-site parking but car parking spaces, including some for blue badge holders, are available near the practice.

The practice opens on Mondays, Wednesdays and Fridays from 9 am to 5 pm; and Tuesdays and Thursdays from 8 am to 6 pm.

The practice is owned by a partnership 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 the practice is the principal dentist.

On the day of inspection, we collected 38 CQC comment cards completed by patients, and spoke with another one. We spoke with both partners, a hygienist and a dental nurse.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring and professional service.

• The practice appeared clean and well maintained.

• The provider had thorough staff recruitment procedures.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• Patients received their care and treatment from well supported staff, who enjoyed their work.

• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.

• Members of the dental team were up-to-date with their continuing professional development and were supported to meet the requirements of their professional registration.

• The practice could not assure itself that the sedation of patients was undertaken according to 'Standards for Conscious Sedation in the Provision of Dental Care 2015 guidelines.

• The justification for taking X-rays was not always recorded on patients notes and the practice had failed to notify the Health and Safety Executive in the change of ownership of the X-ray units. Rectangular collimation was not used to reduce patient radiation dosage.

• Antibiotics were not always dispensed in the original manufacturer’s packaging and information leaflets about the medication were not always given to patients.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

• Review the practice’s responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.