We carried out this announced inspection on 20 December 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 not providing well-led care in accordance with the relevant regulations.

Background

Teeth for Life is in Stoke on Trent and provides NHS and private treatment to adults and children. The service offers treatment under conscious sedation for adults.

Due to the first-floor location of the surgery, access for people who use wheelchairs and those with pushchairs is not possible. Patients who cannot manage the stairs are signposted to a local accessible practice.

Car parking spaces are available near the practice.

The dental team includes one dentist, one dental nurse, two receptionists and a domestic cleaner. The practice has one treatment room and a recovery room.

The practice is owned by the principal dentist. 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 44 CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with the dentist, the dental nurse and one receptionist. 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 12pm and 1pm to 5pm

Our key findings were:

• The practice appeared clean.
• Some infection control procedures did not always reflect published guidance. There was no hot water at the handwashing sinks in the surgery.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• Systems to identify and manage risks associated with fire, Legionella and substances hazardous to health were not effective.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures. Minor improvements could be made to this process.
• The dentist 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.
• Staff felt involved and supported and worked well as a team. There was a clear no blame culture within the practice.
• The provider asked patients for feedback about the services they provided.
• The provider had an accessible complaints procedure.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider is not meeting are at the end of this report.

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

• Review the protocols for use of radiographs taking into account the guidance provided by the Faculty of General Dental Practice.

We carried out this inspection to check on the care and welfare of people using this service. Our inspection was discussed and arranged two days in advance. This was to ensure that we had time to see and speak to staff working at the practice, as well as people registered with the service. We consulted the local PCT and reviewed the comments on the Choices NHS website.

People we spoke with who used the service told us they were fully involved in the treatment they received and knew why it was needed. One person told us, “I am always asked about my medical health and if I have had any changes”.

People we spoke with told us that they were happy with the service and staff treated them respectfully. One person told us, “The staff are very kind, patient and understanding with me”. Staff we spoke with explained the actions they would take to reassure people who were nervous of dental treatment.

We saw that the service had facilities in place to undertake the sterilisation of instruments in line with national guidelines. Staff we spoke with explained the processes they followed to ensure that equipment was sterilised.

Staff we spoke with told us that they felt supported by their manager to carry out their role effectively. We saw records that staff had opportunities to update their professional development.

The provider had systems in place to gain feedback from people who used the service. People told us that they knew how to complain if they needed to.