We carried out this announced inspection on 15 November 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

Sharrow Dental Surgery is in Chelmsford, Essex and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, are available behind the practice.

The dental team includes 12 dentists, ten dental nurses, one dental hygienist, three receptionists and the practice manager. The practice has eight treatment rooms, three on the ground floor and five on the first floor.

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 collected 16 CQC comment cards filled in by patients and spoke with four other patients.

During the inspection we spoke with three general dentists, the implantologist, the sedationist, the orthodontist, four dental nurses, one dental hygienist, one receptionist 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 Friday from 8am to 5.45pm. Saturday and Sunday from 9am to 12pm.

Our key findings were:

• The practice appeared clean and well maintained.
• 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 available. We noted training for three members of staff was overdue.
• The practice had systems to help them manage risk.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice provided intra-venous sedation to those patients who would benefit.
• The practice had staff recruitment procedures; we found that some of these required strengthening.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• All consultations were carried out in the privacy of treatment rooms. We found external windows at the front of the practice gave clear views of patients in some treatment chairs.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs. Saturday and Sunday morning appointments were available.
• 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 staff had suitable information governance arrangements.

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

• Review the practice’s recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
• Review the practice's protocols and procedures to ensure staff are up to date with their mandatory training and their continuing professional development.
• 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. In particular ensure there is oversight of the servicing and maintenance of X-ray equipment and ensure this is undertaken in a timely manner.
• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the practice arrangements to ensure patients privacy and dignity is maintained in treatment rooms.

We carried out this responsive follow-up inspection to check that the required improvements to the service had been carried out.

People we spoke with told us that they felt safe and well cared for by the dentist and staff.

We saw that the required improvements to the service so as to protect people against the risk of abuse had been achieved.

Staff had access to appropriate safeguarding training, information, policies and procedures to assist them to recognise and report any concerns about the safety and welfare of people who used the service. Staff were aware of their responsibility to keep people safe and to support people who lacked capacity to make decisions about the care and treatment that they received.

We saw that the provider had suitable arrangements for protecting people against the risk of abuse or harm.

We spoke with three people who use the service.

All three people said that they had been fully informed about the treatment options and had felt involved in the decision-making process. They said they had been made to feel comfortable and that the dentist they saw had answered their questions fully. They were pleased with the outcomes of their treatments. They had been asked whether they had any allergies and to provide a full medical history at each visit.

All three people said they would recommend the practice to other people.