We carried out this announced inspection on 29 June 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information for us to take into account.

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

Park Dental Studio is in Boston, a town in Lincolnshire and provides mainly NHS treatment to patients of all ages. The practice also provides private treatment to approximately 5% of its patient list.

There is a step to gain access to the premises. The provider has a portable ramp to enable level access for people who use wheelchairs and pushchairs. Car parking spaces are available at the rear of the premises and there is one space allocated for disabled patients with blue badges at the front of the building. On street parking is also available opposite the practice.

The dental team includes one dentist, two dental nurses (including a trainee nurse), one dental hygienist and two receptionists. One of the practice nurses assists with practice administration.

The practice has four treatment rooms; one is located on the ground floor.

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 Park Dental Studio is the principal dentist.

The principal dentist joined the practice in 2011 and there are current plans in place to recruit an additional dentist. The practice premises have been subject to extensive renovation to modernise the building. This has included a redesign of the waiting and reception area, the treatment rooms and decontamination room. The provider has been making enquiries regarding replacing the existing staircase. New dental equipment has also been purchased.

On the day of inspection we collected 24 CQC comment cards filled in by patients. This information gave us a positive view of the practice. We did not receive any negative comments about the practice.

During the inspection we spoke with the dentist, two dental nurses and a receptionist. 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 1pm and from 2pm to 5.30pm.

Our key findings were:

• The practice ethos included the provision of high quality dental care for their patients at appropriate intervals alongside the promotion of good oral health.

• Effective leadership was evident although we found some areas where management arrangements could be strengthened.
• Staff had been trained to deal with emergencies. We found appropriate medicines were readily available in accordance with current guidelines. We found there were some items of equipment for use in medical emergencies which were missing.
• The practice appeared clean and well maintained.
• Staff demonstrated knowledge in relation to their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• The practice had robust staff recruitment procedures.
• Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The practice demonstrated awareness of the needs of most of the local population and took these into account when delivering the service.
• Patients had access to treatment and urgent and emergency care when required.
• The appointment system met patients’ needs.
• Staff received training appropriate to their roles. Staff were supported in their continued professional development (CPD) by the practice.
• Staff we spoke with felt supported by the provider and were committed to providing a quality service to their patients.

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

• Review the practice’s system for documentation of actions taken, and learning shared, in response to incidents with a view to preventing further occurrences and ensuring that improvements are made as a result.

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies, such as Public Health England (PHE).

During our inspection we spoke with four members of staff and four patients who used the service as well as the practice manager.

The patients we spoke with were complimentary about the way staff respected them and involved them in their treatment options. One patient told us, “I get very good treatment here.”

Patients told us they consented to any treatment they had and had known how much it was going to cost before signing the consent form.

The practice had robust systems and procedures in place to reduce the risk of infection. A patient told us, “They’re really good here. Everything’s clean and the dentist always wears gloves.”

The provider did not have systems in place to ensure appropriate checks were undertaken before staff began work. Required documentation was not always present. Policies and procedures for undertaking risk assessments for staff where appropriate were not in place, for example if a criminal conviction appeared on a criminal record check.

Systems were in place in place to make sure risks to patients were identified and managed effectively.