We carried out this announced inspection on 2 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

Spedding Dental Clinic is in Carlisle and provides private treatment to patients of all ages and NHS funded treatment to children.

There is level access for people who use wheelchairs and those with pushchairs at the rear of the building. On street car parking is available near the practice.

The dental team includes eight dentists, nine dental nurses, two dental hygienists, one dental hygienist therapist, two receptionists, a practice manager and a practice administrator. The practice has five 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 Spedding Dental Clinic was the principal dentist.

On the day of inspection, we collected 36 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, three dental nurses, a 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 – Wednesday 8.00am – 5.30pm

Thursday 8.00am – 6.00pm

Friday 8.00am – 4.45pm

Our key findings were:

• The practice staff appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. Staff did not wear appropriate protective equipment when packing sterile instruments.
• Staff knew how to deal with emergencies. Life-saving equipment for children was not available. The storage boxes for emergency medical equipment were cumbersome which could affect the time staff took to start emergency procedures.
• 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 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.
• 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.
• Staff appraisals had not been undertaken annually.
• 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 security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice's protocols to ensure audits of radiography are undertaken at regular intervals and, where applicable, learning points are documented and shared with staff.
• Review the staff supervision protocols and ensure an effective process is established for the on-going appraisal of all staff.
• Review the availability of medicines and equipment to manage medical emergencies taking into account the guidelines issued by the British National Formulary, the Resuscitation Council (UK), and the General Dental Council.

We spoke to four people who used the service. We found that people were happy with the service at Spedding Dental Clinic and were involved in the treatment they received. One person said “He (the dentist) gives me all the options and it’s all written down. I don’t have to decide then and there, I can think about it and let him know. I know how much things are and there are different ways to pay”. Another person said, “I feel completely at ease. The staff are lovely and I’m well looked after. I wouldn’t go anywhere else”.

We found that people were protected from the risk of infection because appropriate guidance had been followed and they were treated in a clean and hygienic environment. One person told us, "It's spotless".

Emergency care could be given if needed because staff had been trained and emergency equipment was checked regularly and available to use.

The provider had effective systems to regularly assess and monitor the quality of service that people received, we found people's views were sought and suggestions acted upon.

Effective recruitment processes were in place and appropriate checks were carried out before staff began working at the clinic thus ensuring people were treated by suitably skilled and experienced staff.