We carried out this announced inspection on 19 February 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 providing well-led care in accordance with the relevant regulations.

Background

Regency House Dental Practice - Stone provides NHS and private treatment to adults and children. In addition to the general dental provision the practice provides orthodontic treatments. Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. Orthodontic treatment is provided under NHS referral for children except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available in the practice car park. Additional car parking including spaces for blue badge holders, are available in pay and display car parks near the practice.

The dental team includes four dentists, a visiting implantologist, two dental hygiene therapists, two dental hygienists, eight dental nurses, one receptionist, one decontamination lead and the practice manager. The practice has five treatment rooms.

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 Regency House Dental Practice - Stone is the principal dentist.

On the day of inspection, we collected 47 CQC comment cards filled in by patients and spoke with one patient.

During the inspection we spoke with three dentists, four dental nurses, one dental hygienist, the decontamination lead 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 Wednesday from 9am to 5.15pm.

Thursday from 9am to 6.15pm.

Friday from 9am to 2pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which mostly reflected published guidance. An annual statement of decontamination had not been completed annually and Infection prevention control audits had not been completed every six months in line with recognised guidance. This was immediately rectified and evidence was sent to us within 48 hours of our visit.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff. The practice held safety data sheets for all products,; but had not completed risk assessments in accordance with their control of substances hazardous to health policy. A fire risk assessment had been completed which outlined routine checks for completion, these were not being completed within the timeframes outlined in the risk assessment.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Safeguarding flowcharts containing relevant local authority safeguarding contact details were on display in the practice managers office and available in reception and treatment rooms for staff.
• The provider 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.
• Staff were providing preventive care and supporting patients to ensure better oral health. They routinely referred patients to their dental hygienist and hygiene therapists through a clear care pathway. Several dental nurses had completed oral health education and topical fluoride application training to support patients with oral health education and tooth brushing advice.
• The appointment system took account of patients’ needs. Patients could access routine treatment and urgent care when required. The practice offered extended hours appointments opening until 6.15pm on Thursdays.
• The provider had effective leadership and culture of continuous improvement. Several dental nurses had completed extended duty dental nurse qualifications in radiography and impression taking training to enhance patient support.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided. Results of feedback were analysed and discussed at staff meetings to share learning. Friends and Family Test results were on display in the waiting room.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the 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’. In particular ensuring infection prevention control audits are completed every six months and an annual statement of decontamination is completed.
• Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken for all products.
• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was arranged one day in advance. This was to ensure that we had time to see and speak to staff working at the practice, as well as people registered with the service.

People receiving care and treatment at this practice received paid NHS charges, however some people chose to pay privately. We spoke with one person in the waiting room who told us that their treatments had always been arranged at a time convenient to them. They told us: “I have been here for many years and brought my son today who is in pain. They have been very good to him. I recommend the practice to lots of people. The staff are all very friendly and kind”.

We spoke with people that were new to the practice and some people that had been at the practice for many years. We spoke with people that needed support with mobility and they told us that their appointment was always arranged for the ground floor surgery. Some people told us that the whole family attended including their relatives and friends. One person told us: “I have never had any cause for concern. I get treated well”.

People we spoke with told us that the practice always looked very tidy and they were satisfied with the standards of cleanliness. During the inspection we saw that there were good standards of hygiene and infection control practices.