We carried out this announced inspection on 15 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 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

Nicol Dental Practice is in Stockport, Cheshire and provides NHS and some private treatment to adults and children.

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

The dental team includes five dentists and three dental nurses, one of whom is also the practice manager. The practice team is afforded additional administrative support and clinical leadership by one of the partners Mr Albert Joubert. At the time of our inspection, an additional part-time staff member was going through the process to become registered manager at the practice. The practice has four treatment rooms one of which is at ground floor level and fully accessible for wheelchair users.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission (CQC) 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. At the time of this inspection CQC had received and validated an application for a Registered Manager at Nicol Dental Practice, which was being processed.

On the day of inspection, we collected 36 CQC comment cards filled in by patients. All feedback received was positive.

During the inspection we spoke with three dentists, two dental nurses, one receptionist and the practice manager. We also spoke to the staff member who is applying to be the Registered Manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Friday, from 8.30am to 1pm and from 2pm to 5pm.

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. We brought to the attention of the provider that the size of the oxygen cylinder on site fell just below the recommended size for dental practices.
• 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 promoted continuous improvement, for example through staff training and audits.
• 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 record keeping in relation to the management of regulated activities and people employed. In particular, certificates issued following critical acceptance testing of radiography equipment, and records relating to titre levels of staff immunised against Hepatitis B.
•  Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council. In particular, the size of oxygen cylinder held on the premises to ensure that this is at least the recommended size, and that this is sufficient for the needs of the practice.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account the guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’. This should also include other local and national initiatives and toolkits, for example the Dementia Toolkit, Saving Smiles and the Healthy Living Dentistry Scheme.