We carried out this announced inspection on 27 February 2018 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 of concern.

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

Queensway dental clinic is located in Billingham and provides NHS and private treatment to adults and children. The dental clinic is spread across two buildings; the main building being predominantly for NHS treatments and the opposite “crown” building being for private treatments. Each building has it’s own reception, waiting area, a dedicated sterilisation suite and patient facilities. There are 17 treatment rooms between the two sites.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available, including a multi-storey car park opposite the practice.

The clinic provides general dental treatment and specialist dental treatment including oral and maxillofacial surgery, complex endodontics, conscious sedation, implants, specialist orthodontics (by referral to their sister practice which is on the 1st floor of the “crown” building) and specialist restorative procedures. In addition, there is a dental laboratory within the premises.

The dental team includes five principal dentists, five associate dentists, five specialist oral surgeons, a dentist with specialist interest in endodontics, an oral and maxillofacial surgeon, a restorative dentist, two dental hygienists and five dental therapists. In addition, there are seven reception staff, 25 dental nurses, three sterilisation technicians, a governance and compliance manager, patient support supervisors, a patient treatment advisor, a dedicated stock controller and a business administrative team.

Queensway dental clinic is an accredited teaching practice in extended duties for dental nurses –such as oral health, sedation, implant assistance and radiography. An on-site education centre provides facilities for these courses and also for continuing professional development for all dental professionals.

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 managers at Queensway dental clinic are one of the principal dentists and the governance manager.

On the day of inspection we collected 10 CQC comment cards filled in by patients which gave us a positive view of the practice.

During the inspection we spoke with the governance and compliance manager, three dentists, the treatment advisor, five dental nurses, a sterilisation technician, a dental therapist, a dental hygienist and reception staff.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Friday8:15am – 5:30pm.

Our key findings were:

• The practice was clean, well maintained and had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies and appropriate medicines and life-saving equipment were available.
• The practice had 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.
• Clinical staff provided patients’ care and treatment in line with current guidelines for general dentistry, implants and specialist treatments.
• 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 supported and worked well as a team.
• Staff well-being was evidently a large priority to the partners of the practice. Numerous health and well-being options were available to staff.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice was largely involved in oral health promotion and provided dental care abroad. Oral health talks were given to various groups (schools, dementia clinics) throughout the region.

We identified areas of notable practice.

• Diabetes risk assessment was carried out by the dental hygienist using a set of seven questions. Those deemed at risk of diabetes were then referred to their general practitioner and the risk assessment sent with the referral.
• Staff well-being was evidently a priority. Various measures for team building and learning were in place, as well as free access to support groups. In addition, physical aids were provided and exercise events such as yoga and walking also took place.
• Staff participated in oral health discussions with local communities such as schools, autistic groups and dementia groups. There were reciprocal learning measures in place with some of these groups to help both the dental team and the community.

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

• Review the practice's policy for assessing hazardous products identified under the Control of Substances Hazardous to Health (COSHH) 2002 Regulations and ensure a risk assessment is undertaken for all relevant materials held on-site.
• Review the practice’s systems for tracking and monitoring antibiotics and prescription pads.

We spoke with four people who used the service. People said that they were very happy and that they saw the dentist on a regular basis. They confirmed the dentists, dental nurses, therapists and hygienists always explained what they were doing and what the treatment options were. One person we spoke with told us, “I was given a written plan including the costs.” Another person said, “They are very good, very professional.”

We saw that treatment plans were developed and people’s care was delivered in accordance with their plans.

We found that people were protected from the risk of infection because processes were followed to ensure care was delivered in a clean and hygienic environment.

We found there was a recruitment procedure in place and appropriate checks were carried out on staff before they started work.

People told us that they would feel comfortable in raising a concern or complaint with staff working at the practice.