We carried out this announced inspection on 30 October 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.

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 not 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

Reece Associates LLP is in Sutton Coldfield 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 outside the practice but there are no dedicated car parking spaces for patients who are blue badge holders.

The dental team includes five dentists, eight dental nurses (two of whom are trainees), three dental hygienists, one dental hygiene therapist, two practice managers, one decontamination assistant and one receptionist. The dental nurses also carry out reception duties. There is also a visiting sedationist who provides sedation services for patients when needed. The practice had 5 treatment rooms at the time of our visit. However, it was undergoing refurbishment and will have 7 treatment rooms upon completion within the next month.

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 Reece Associates LLP is the practice manager.

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

During the inspection we spoke with two dentists, one dental nurse, one receptionist, the registered manager and the deputy practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Wednesday 8.30am - 5.30pm

Thursday 10.00am - 8.00pm

Friday 9.00am - 2.30pm

The practice is also open one Saturday per month between 9am and 1pm.

Our key findings were:

• The practice appeared clean and well maintained. The structure and layout of the decontamination room required improvements. Staff had already identified this and these changes would be made shortly upon completion of the refurbishment.
• The practice had infection control procedures which reflected published guidance. Some necessary improvements were required.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. One emergency medicine was not stored in accordance with manufacturer’s guidelines.
• The practice had limited systems to help them manage risk.
• The practice staff had safeguarding processes and they knew their responsibilities for safeguarding adults and children, although some of their training was overdue.
• The practice had staff recruitment procedures but these were inconsistent and incomplete.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice did not have effective leadership.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable 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 not meeting are at the end of this report.

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

• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010. They should also review the availability of interpreting services for patients who do not speak or understand English.

As part of our review of the service, we spoke with two people during our visit and three people on the telephone following our visit.

20 surveys were returned to us from people using the service to tell us their views of the service provided.

People attending Reece dental practice on the day of our visit told us they were very happy with the service and treatment they received. They told us all treatment was explained to them and the choices they made were respected.

The staff are friendly and made them feel welcome and put them at ease.

They had no complaints about the service they received and were more then satisfied with their treatment.

Information taken from the surveys that people filled in included:

“Always helpful and informative’’.

“They give you full details of the treatment they are planning to do and discuss all options with you’’.

“Everyone in the practice is approachable and welcoming. I have been to other dentists before, but this is by far the best one’’.

Information that we gathered during this review confirmed that people are assessed to decide what dental and oral healthcare needs they may have. The treatment that people had received had been discussed with them.

We found that people receive treatment in an environment, which was clean and managed to reduce the risk of infections