We carried out this announced inspection on 14 December 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. NHS England provided us with information about contracts they hold at the practice.

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 Vale Dental Surgery is in Falmouth and provides NHS and private treatment to patients of all ages.

Access for people with wheelchairs/ parent with buggies was restricted. Car parking spaces were available on surrounding streets, or in the town centre.

The dental team includes two permanently employed dentists, two dentists employed on a locum basis, three trainee dental nurses, one dental nurse renewing their registration/receptionist, one additional receptionist and a practice manager. The practice manager is supported by a senior management team. The practice has four treatment rooms.

NHS England provided us with information about the contracts they hold at the practice. They held two contracts, one with Park Vale Partnership and another with a limited company. The day to day managerial arrangements at the practice were carried out by the limited company but one of the partners was also director of the limited company. As a condition of registration the partnership 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. One of the partners was the CQC registered manager. We were told that there were plans to apply to de-register the partnership at the practice and manage the practice contracts under the current registration for the limited company.

On the day of inspection we collected 27 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, two trainee dental nurses, one dental nurse/receptionist (in the process of renewing their registration with the General Dental Council), the practice manager, the area manager, another member of the management team and a company director (who was also one of the partners of the second contract/registration held at the practice). We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday 9am – 5pm. The practice is closed for lunch between 1pm – 2pm daily.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures that would benefit from review to reflect published guidance.
• Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. Some risk assessments would benefit from review.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice staff recruitment procedures had not been consistently followed but risk assessments were in place to protect patients from risk.
• The clinical staff broadly provided patients’ care and treatment in line with current guidelines but guidance protocols informing the recall of child patients was not always followed.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• Improvements had been made to deal with complaints positively and efficiently.

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

• Review the practice’s testing protocols for equipment used for sterilising used dental instruments, reassess effectiveness of air flow in the decontamination room, review legionella risks and associated dental line flushing protocols. The review should take into account guidelines issued by the Department of Health - 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.

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.

• Review the practice's environmental risk assessments and ensure a fire risk assessment is undertaken and the necessary actions implemented. This should be supported by a formalised business continuity plan.

• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act (2010).