We carried out this announced inspection on 9 April 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 not providing well-led care in accordance with the relevant regulations.

Background

Station Road Dental Surgery is a well-established practice based in Beccles that provides both NHS and private dental treatment. There is a branch practice close by and between them, they provide dental services to about 23,000 patients. Some of the staff work across both sites, and the team in total consists of nine dentists, one hygienist and 20 dental nurses. At this site there are four treatment rooms.

The practice opens on Mondays to Thursdays from 8 am to 5.30 pm, and on Fridays from 8 am to 3.30 pm.

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 20 CQC comment cards completed by patients. We spoke with three dentists, three dental nurses and reception staff. We also spoke with four patients.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring and professional service.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff provided preventive care and supported patients to ensure better oral health.
• Patients’ complaints were dealt with positively and efficiently.
• The management of risk was limited and potential hazards within the practice had not been fully assessed to reduce potential harm.
• The practice’s sharps procedures were not in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• The quality of recording in patients’ dental care records was variable and did not always take into account guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Pre-employment checks were not always undertaken to ensure staff were suitable to work with vulnerable adults and children.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare Products Regulatory Agency (MHRA).

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

• Review the practice's protocol and staff awareness of their responsibilities under the Duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Review the practice’s responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

We spoke with seven people attending for appointments and with their permission we accompanied three people during their consultation and treatment. All praised the relaxed, friendly atmosphere and spoke positively about the quality of the service. One person described the service as, “Excellent,” and told us, “I’ve never had any problems at all.”

People told us they felt respected by staff and were fully involved in the decisions about their dental care and treatment. One person said they found the staff to be, “Always efficient and polite.” Another person told us, “My dentist is really, really good, listens to me, explains everything which helps build up trust…I hope he doesn’t leave.”

When we asked people if they would recommend the service to others, they told us they would. One person replied, ”I always do, I say don’t go to that one, come to mine.”

We observed that the reception and clinical areas were clean and tidy. As we gave short notice of our inspection, we asked people if they always found it to be of the same standard. They told us they did. One person described the standard of cleanliness as, “Brilliant, it’s always clean and tidy.” Another person remarked, “I don’t know who does the cleaning, but they can come and do mine.”