We carried out this announced inspection on 16 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

Old Market Dental Practice is in Sturminster Newton and provides NHS and private treatment to adults and children.

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

The dental team includes two dentists, one lead dental nurse, one trainee dental nurse, two dental hygienists, one cleaner, one practice manager and one receptionist. The practice has three 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 Old Market Dental Practice is the senior partner. The practice manager was undergoing the application process to replace the current registered manager who was leaving the company. A registered manager is legally responsible for the delivery of services for which the practice is registered

On the day of inspection, we collected ten CQC comment cards filled in by patients and spoke with two other patients.

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

The practice is open:

Monday to Friday 8.30am to 5.30pm

Our key findings were:

• The practice appeared clean and well maintained although air vents were dusty. Improvements could be made to the cleaning file with additional documentation.
• 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 practice should implement risk assessment actions for recent fire and legionella risk assessments.
• The practice should give consideration to risk assessments for the high volume of work the dentists were expected to complete.
• Improvements could be made to the room layout for X-rays, it was not possible to directly monitor patients continuously and stay a safe distance away from the equipment.
• 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.
• Improvements could be made to the allocation of chairside support to the dental hygienist who had requested a review of working practices.
• 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, however improvements could be made to the auditing processes, including antimicrobial stewardship prescribing audits
• Improvements could be made to Control of Substances Hazardous to Health (COSHH) Regulations 2002 file to ensure the safe storage and use of materials used.
• 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 policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.

• Review the practice’s protocols to ensure audits of radiography, dental care records, infection prevention and control, and antibiotic stewardship are undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities, in particular dentists work loads.

• 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.

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During the inspection, we spoke with two people who use the service. They told us the dentist explained the treatment options and they were asked for written consent. We found that people were asked for consent and the provider acted in accordance with people’s wishes.

People who use the service received care in a way that met their needs and preferences. The people we spoke with told us they were happy with the services they received. They told us they were given a prompt appointment when they contacted the practice.

We found the environment and equipment in the practice to be clean, safe and well maintained. The people we spoke with told us they did not have any concerns about the cleanliness of the premises or the dental equipment and instruments.

There were enough qualified, skilled and experienced staff to meet people’s needs. The people we spoke with told us the staff were friendly and helpful.

There was an effective complaints system available, in case anyone wished to raise a complaint. The people we spoke with told us they had no concerns about the services they received and would speak to the staff if they had any concerns.