We carried out this announced inspection on 7 December2017 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. We received some supporting information of concern from them.

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

Prudhoe Dental Practice is in Prudhoe, Northumberland and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces were available ear the practice.

The dental team includes four dentists, three dental nurses, a dental hygienist, two receptionists who are support by the practice owner and a practice manager.

The practice has three surgeries. Two on the first floor and an accessible surgery on the ground floor, a decontamination room for sterilising dental instruments, a staff room/kitchen and a general office.

The practice is owned by an individual who is the principal dentist across three other sites also. 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 12 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with three dentists, three dental nurses, a receptionist, the practice owner 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 9am – 7pm

Tuesday, Wednesday & Thursday 9am - 5:30pm

Friday 9am – 5pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Not all appropriate medicines and life-saving equipment were available and this was held in several locations within the practice.
• The practice had minimal systems to help them manage risk.
• The practice 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.
• 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.
• The practice dealt with complaints positively and efficiently.

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

• Review availability of medicines and equipment to manage medical emergencies taking into account guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the practice’s sharps procedures and ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. Review all other practice specific risk assessments and reporting procedures including RIDDOR.
• Review the systems for checking and monitoring electrical and gas safety taking into account current national guidance and ensure that all equipment is well maintained.
• 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.
• 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”.

We spoke with four people to find out their opinions of the service they received. One person said, “I travel from Newcastle to come to this practice, so it must be good. We’ve been going since the 70s.” Another person said, “It’s a really good service, it’s spot on.”

People told us they were involved in planning their treatment and they were given information and possible treatment options. One person said, “I’ve told them I don’t like to talk about it so they give me an overview; but when I go with my children they discuss it lots and go through things in detail. They really tailor it and involve the children which I like.”

We found that care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

We saw that the provider had a safeguarding policy in place which detailed the actions to be taken should staff have concerns about care or witness a safeguarding incident.

Appropriate checks were undertaken before staff began work.

Staff informed us they were appropriately trained and supported in their role.

We confirmed the provider had a detailed and effective quality monitoring process in place.