We carried out this announced inspection on 18 December 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

Ringway Dental Care is in Heald Green, Stockport, Cheshire and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Some car parking spaces are available immediately outside the practice, with additional street parking near the practice.

The dental team includes a principal dentist, a visiting dental implantologist, two dental nurses and a receptionist. The practice has two 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 Ringway Dental Care is the principal dentist.

On the day of inspection, we collected 12 CQC comment cards filled in by patients. All feedback was positive.

During the inspection we spoke with the principal dentist, two dental nurses and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday and Tuesday from 8.30am until 5.00pm, Wednesday 11am until 7.00pm, Thursday 8.30am until 6.30pm and on Friday 9.00am until 3.00pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. However, staff were not following manufacturer instruction when using products to clean dental unit water lines.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available but some of this required separating from medicines and appliances that were out of date or redundant so not suitable for use.
• Systems to help manage risk to patients and staff required review, risk assessments for management of legionella, for management of radiation equipment and for conducting efficacy testing on dental instruments that had been through the decontamination process.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Training for some staff and policies required updating.
• The provider had staff recruitment procedures clearly outlined in their recruitment policy but these were not always followed.
• Other areas of recommended training for some staff required updating.
• 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.
• The appointment system took account of patients’ needs.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with any complaints or concerns raised positively and efficiently.
• The provider had information governance arrangements in place but these required review.

We identified regulations the provider was not complying with. 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.

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

• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment. This includes making the required declaration to the Health and Safety Executive, confirming that all equipment is being used safely and in accordance with the regulations.
• Review the practice's protocols for medicines management and ensure all medicines are stored, prescribed and dispensed of safely and securely. This includes disposing of safely, any medicines that are out of date, and the prescribing of medicines in accordance with latest recognised guidance.

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