We carried out this announced inspection on 09 May 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

Rustington Dental Care is in Rustington, West Sussex and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Parking spaces for blue badge holders are available outside of the practice which is close to local on-street parking.

The dental team includes the principal dentist, three associate dentists, one dental hygienist/therapist, two dental nurses, one receptionist and a business development/acting practice manager. The practice has three 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 Rustington Dental Care was a partner for company.

On the day of inspection, we collected 13 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, two dental nurses, one receptionist and the business development/acting practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday to Friday from 8.30am to 5pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The provider 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 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.
• The practice had effective leadership and a 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 staff had suitable information governance arrangements.

We identified an area of notable practice:

• The practice had daily morning meetings, ‘huddles’, organised in line with the five key questions; is the care provided safe, effective, caring, responsive and well-led.
• Every day the practice asked of its staff: What went well the day before, what could be improved/learned; concerns for risk within the practice; additional training needs; patients with specific needs/important information to be shared; concerns around consent; complaints; the main point of contact for the day; concerns, difficulties or good ideas; help required with any tasks during the day; a motivational thought for the day.
• Staff told us that patients benefitted from the shared in-depth discussions to ensure that their needs were met.
• This approach was fully embedded in the practice having been adopted for over two years. Staff felt that starting the day with these open and productive conversations set the foundation for a culture in which staff go above and beyond for their patients and were motivated to extend their skill set to enhance their own knowledge and the services the practice offered.
• This demonstrated effective communication, a high regard for staff well-being, openness and a culture in which staff were encouraged to and felt confident in sharing their views. It fostered an environment in which the mitigation of risk was a priority.

Our inspection on 11 December 2013 found that care and treatment was not always planned and delivered in a way that was intended to ensure patients’ safety and welfare. There was also no effective complaints system available.

Compliance actions were set asking the provider to take action regarding these concerns. They wrote to inform us that they had taken action to rectify the areas of concern found at this inspection.

We followed up on our inspection of 11 December 2013 to check that action had been taken to meet the compliance action set. We found that Rustington Dental Care was able to demonstrate that they were meeting the compliance actions set in order to rectify the areas of concern identified at that inspection.

During our inspection we spoke with five members of staff, looked at care records for ten patients, spoke with five patients and three relatives of patients.

We saw that patient’s views were taken into account in the way the service was provided and delivered. For example one patient told us that "They give me options and lots of detail”. They also said “Everything is fully discussed.” One patient told us that "They are a very good practice."

We were concerned about the level of non-compliance that we found during our inspection and action is required to improve the following: planning and delivery of care and treatment and providing all patients and their supporters with information about the complaints process.

We looked at ten care records and saw that some did not record details of patient’s medical history and for others those details had not been updated at subsequent treatment appointments. However both dentists told us that they checked their patient’s medical histories at each treatment appointment. This meant that patients were put at risk of receiving care or treatment that is inappropriate or unsafe.

We also noted that treatment plans were only given to patients if they were being offered complex courses of treatment. However, the records showed details of the treatment(s) undertaken. This meant that patients did not receive care that reflected guidance issued by the General Dental Council.

The provider did not make all their patients and supporters aware of their complaints policy. This meant that most patients were deprived of access to information about the complaints procedure.

We saw that the premises were visibly very clean and tidy. Staff we spoke with spoke knowledgeably about decontamination and sterilisation processes they use. One patient we spoke with said “The practice is always clean.”

We saw documentation which confirmed that all relevant staff employed by the service held current registrations with the General Dental Council (GDC). We also saw documents which confirmed that the service held checks with the Disclosure and Barring Service (DBS) for all staff. This meant that the service had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.