We carried out this announced inspection on 15 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 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

Dr Nigel Cranstoun, Robin Hood Dental Practice is in Hall Green, Birmingham and provides private treatment to adults and children. The provider, Dr Cranstoun is one of three dentists who work in the same building under a separate registration with the Care Quality Commission (CQC). Some of the facilities and staff are shared between each practice located in the building. For example, the receptionist, reception area, toilets, staff room, waiting area, hygienist area and first floor X-ray facilities are used by all three dental practices under an expense sharing agreement. This report will make references to the practice but this inspection only related to the services provided by Dr Nigel Cranstoun.

A portable ramp is available to provide access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders, are available at the front of the practice. Parking is also available on local side roads.

The dental team includes one dentist, two dental nurses, two receptionists and a cleaner. Dr Cranstoun also refers patients if necessary to one of the two self-employed dental hygienists or the dental hygiene therapist who also work at the service. The practice has one treatment room.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we received positive feedback from 41 patients

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

The practice is open: Monday to Thursday 8.30am to 5pm and Friday 8.30am to 4.30pm. The practice is closed for lunch each day between 1pm to 2pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. The practice nurses shared the infection prevention and control lead role. HTM01-05 recommends that one member of staff has this role.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. Some changes were required to be made to the risk assessment regarding substances hazardous to health and this was completed following this inspection.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• Dental nurses had worked at the practice for over 27 years, reception staff were employed within the last two years. Suitable staff recruitment procedures were completed for these newly employed staff.
• The clinical staff provided patients’ care and treatment in line with current guidelines. Patients reported that they received a high-quality service which they were happy with.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information. Some improvements were required to the area used by the hygienist and hygiene therapist to maintain privacy and dignity of patients using this service. Following this inspection we were told that quotes were being obtained for work to be completed.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs. Patients told us that the practice were accommodating and they were always seen quickly if they had any dental pain.
• The practice had effective leadership and culture of continuous improvement. Staff said that they worked well as a team and were proud to work at the practice.
• The practice asked patients for feedback about the services they provided. Positive responses were received from patients. Information from completed Care Quality Commission comment cards gave us a positive picture of a professional, caring, high quality service provided by friendly, knowledgeable staff. Many patients had been attending this practice for over 30 years and some stated that they travel over 200 miles to attend the practice.

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

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.

• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular the introduction of a lone workers risk assessment for when the dental hygienist or hygiene therapist worked without chairside support.

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017

Our visit was discussed and arranged with the practice 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 practice.

During the inspection we spoke with the dentist (who was also the registered provider) and two dental nurses. After our inspection visit, we spoke by telephone with seven people who were registered with the practice to ask them about their experiences of the service.

The people we spoke with were very complimentary about the service they had received. Their comments included, “Patient care is excellent”, “Always treated very well” and “I would never go to anyone else.” People told us they were given the information they needed to be able to make an informed decision about their treatment.

Staff received a range of training so that they had up to date knowledge and skills in order to treat people safely when they attended the practice.

People told us that the practice was clean and tidy and they had no concerns about cleanliness. We found that the provider had effective infection control procedures in place. This meant the risk of infection for people using the service was minimised.

There were systems in place that ensured people using the service were asked their views about the service so the provider could use the information to improve.