We carried out this announced inspection on 9 April 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

Noel House Dental Surgery is in Braintree, Essex and provides NHS and private treatment to adults and children.

The practice is accessed by a set of steps and hand rails at the front of the building. Car parking spaces, including spaces for blue badge holders, are available in car parks opposite the practice.

The dental team includes four dentists, three dental nurses and two trainee dental nurses, two dental hygienists, one receptionist and a practice business manager. The practice has four treatment rooms.

The practice is owned by an individual who is the principal dentist there. They 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 collected 49 CQC comment cards filled in by patients and spoke with three other patients.

During the inspection we spoke with three dentists, two dental nurses, one receptionist and the practice/business 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 9am to 5pm, Tuesday from 9am to 6.30pm.

Our key findings were:

• The practice appeared clean and well maintained. Not all cleaning equipment was stored effectively.
• The practice staff had infection control procedures. Infection control audits were undertaken annually and not bi-annually in line with guidance. The practice did not have an annual infection control statement.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of clear face masks, orophangeal airways and suction tubing. In addition, the practice had a minimum supply of adrenaline. Fridge temperatures were not monitored, and Glucagon had not been stored correctly. Within 48 hours the provider took immediate action to replace equipment and medicines and put systems in place to ensure safe storage of medicines.
• The practice had systems to help them manage risk.
• The provider 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of 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 staff dealt with complaints efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’. In particular undertaking bi-annual infection control auditing.

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

During our inspection on 03 May 2013, we spoke with eight patients. They told us they were satisfied with the service and the treatment provided. People told us the staff treated them respectfully and were helpful. We saw that staff spoke politely to people and consultations were carried out in private treatment rooms. One patient told us that their relative did not like going to the dentist because they were nervous but since going to Noel House they were much happier and went for regular check ups.

People told us their treatment options were discussed with them and this enabled them to make informed decisions about their treatment.

We saw processes in place for managing the prevention and control of infection and evidence of effective systems in place to reduce the risk and spread of infection within the service.

We found evidence that staff had received regular supervisions and appraisals, and appropriate pre employment checks had been carried out.

The patients we spoke with were happy with the practice and did not have any concerns or issues about the care they received. We saw evidence that the practice had complaints policies and procedures in place.