We carried out this announced inspection on 21 May 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 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

Rishton Dental Practice is in Rishton near Blackburn and provides NHS treatment to adults and children.

The practice does not have step free access, this is presently under review. There is car parking and local transport facilities near the practice.

The dental team includes a practice manager, dentist, dental nurse and 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. At the time of the inspection the practice did not have a registered manager in post, the practice manager informed us that he was in the process of registering with the CQC.

On the day of inspection we collected 23 CQC comment cards filled in by patients.

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

The practice is open: 9am -5:30pm Monday to Thursday and 9am -3:30pm Friday.

Our key findings were:

• The practice appeared clean but some areas of the practice were in need of refurbishment.

• The practice staff had infection control procedures which reflected published guidance.

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were in place with the exception of adult masks, self-inflating bag and the correct storage of glucagon.
• The practice had systems to help them manage risk such as electrical and gas safety. Fire and X-ray processes could be improved.
• The practice staff 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, more care was needed to protect some personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• 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 staff dealt with complaints positively and efficiently.
• The practice had policy documents and information provided by the company which were too generic and not specific to the practice.

There were areas where the provider could make improvements. They 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
• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.
• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

We did not speak to people who used the service during this visit. We spoke with two members of staff and observed the environment.

At our previous inspection visit on 20 August 2013 we found improvements needed to be made to the infection control measures which were in place in the practice.

Following the inspection visit we were sent an action plan informing us how the provider intended to ensure people were protected against the risks of infection when they visited the practice.

We revisited the service to ensure the necessary actions had been taken. We found the provider had made significant improvements to the environment. This meant people were protected from the risk of infection.

People were happy with the care and treatment they received at the dental practice. One person told us "'I like coming here; the staff are so helpful”. People spoken with told us they were always able to get appointments to suit their needs.

Most of the people we spoke with told us they were provided with good information about the treatments and the costs and felt they had been given enough time and information to make a decision about their treatment. We observed staff treated people in a kind, professional, friendly and respectful manner.

We found improvements needed to be made to the infection control measures which were in place in the practice. However, people we spoke with had no concerns about the cleanliness of the environment.

Staff told us that they felt well supported and we found that they had the necessary skills and training to undertake their role in a safe and appropriate manner.

We found that appropriate records were maintained in accordance with good practice guidelines.

We did not speak to people using the service during this visit. We spoke to two members of staff and observed the environment.

We found that the service had adequate systems in place to ensure the environment was clean and people were protected from the risk of infection.

The premises were adequately maintained and provided a reasonable environment for people to receive treatment. The provider informed us that there was an intention to relocate the service to more suitable premises by 1st February 2013.

People attending the practice for treatment told us they were very satisfied with the care they received. They were treated well and the dentist and staff were good.

They said their treatment was given in private and staff treated them with respect. They could discuss their treatment with the dentist. They were given enough information about procedures that were having and what they should expect in the long term.

Parents attending with their children told us their children were involved in their treatment plans and were treated well. Comments were made such as, “She doesn’t mind coming at all,the dentist is very good”.

Children attending the practice said they liked the dentist.