We carried out this announced inspection on 31 October 2017 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.

We told the NHS England Cheshire and Merseyside area team that we were inspecting the practice. We did not receive any information of concern from them.

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

Smiles by Design is in the centre of Chester and provides dental care and treatment to adults and children on an NHS and privately funded basis. The practice also provides dental sedation on a privately funded basis.

There is level access to facilitate entrance to the practice for people who use wheelchairs and for pushchairs. The practice has three treatment rooms. Car parking is available near the practice.

The dental team includes a principal dentist, an associate dentist, a dental hygienist and four dental nurses. The team is supported by a practice manager, who is also a dental nurse.

The practice is owned by a company and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a 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 Smiles by Design is the principal dentist.

We received feedback from 15 people during the inspection about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to two dentists, dental nurses and the practice manager. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday to Thursday 8.30am to 5.00pm, (alternate Thursdays until 7.00pm)

Friday 8.30am to 4.00pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available.
• The practice had a procedure in place for dealing with complaints.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
• The practice had a leadership structure. Staff felt involved and supported.
• The practice asked patients and staff for feedback about the services they provided.
• Staff were supported to complete training appropriate to their roles. The practice did not effectively monitor recommended training to ensure this had been completed.
• The practice had staff recruitment procedures in place. The practice did not consistently follow these when recruiting staff.
• The practice had systems in place to help them manage risk. Risk management of staff Hepatitis B immunity status and sharps was not effective.

There were areas where the provider could make improvements and should:

• Review the practice's recruitment procedures to ensure they are in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, that the necessary employment checks are in place for staff and the required specified information in respect of persons employed by the practice is available.
• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities, specifically in relation to ‘sharps’ and in relation to the monitoring of staff Hepatitis B immunity status.
• Review the practice’s protocols for conscious sedation, taking into account current guidance on conscious sedation in dentistry.
• Review the practice’s system for monitoring staff training to ensure staff are up to date with their recommended training and their continuing professional development.