We carried out this announced inspection on 29 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 not providing well-led care in accordance with the relevant regulations.

Background

Pomfret & Farrell Dental is in Chelmsford, Essex and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available in the practice car park behind the practice. Short and long stay car parks are available near the practice.

The dental team includes four dentists, eight dental nurses, two dental hygienists, five receptionists and the practice manager. The practice has five treatment rooms.

The practice is owned by a partnership 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 Pomfret & Farrell Dental was one of the partners.

On the day of inspection, we collected 39 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with three dentists, three dental nurses, one dental hygienist, one receptionist 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 from 9am to 5.30pm.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. We found the practice did not have records of six monthly infection control audits however.
• Staff knew how to deal with emergencies. Appropriate medicines and some life-saving equipment were available. The practice was missing some essential medical emergency equipment such as some clear face masks. Other items were stored loose in a dusty state in an open plastic bag.
• Risk assessments to identify potential hazards were limited.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Audits to assess the quality of service were limited.
• There was no system to ensure that untoward events were analysed and used as a tool to prevent their reoccurrence.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect. We found that not all dental care records were stored securely.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• 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 positively and efficiently.
• The practice staff had some information governance arrangements.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was/is not meeting are at the end of this report.

• Review the practice’s protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
• Review the practice's protocols for patient assessments and ensure they are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance.
• Review the practice's storage of dental care records to ensure they are stored securely.

People we spoke with said the staff were friendly and approachable. One person told us, “They are lovely and are very respectful.” Another person said, “Excellent, first class. I am always made to feel welcome.”

People told us they felt they had been given sufficient information about the costs of the treatment they required. One person commented on the environment and said, “It is pristine, very clean.”

People we spoke with told us they thought the time they spent in the waiting room was acceptable. One person said, “I only waited for two minutes and I was called through to see the dentist.” Another said, “Usually the longest wait is around 10 minutes.”