We carried out this announced inspection on 9 January 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

The Dental Practice is in Bolton and provides NHS and private treatment to adults and children.

A portable ramp is provided for people who use wheelchairs and those with pushchairs. On street parking is available near the practice.

The dental team includes three dentists, four dental nurses (one of whom also manages the practice) and a dental hygiene therapist. The practice has three treatment rooms.

The practice is owned by a partnership but is registered as an individual provider. 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. We highlighted the need to ensure the practice is registered correctly.

On the day of inspection, we collected 21 CQC comment cards filled in by patients. Patients were positive about staff, the premises and the services provided.

During the inspection we spoke with the principal and an associate dentist, dental nurses 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 8.45am to 12.15pm and 1.45pm to 5.15pm

Our key findings were:

• The premises were clean but in need of refurbishment.
• The provider had infection control procedures which reflected published guidance. Improvements could be made to the treatment environment and processes to validate equipment.
• Staff knew how to deal with emergencies. Emergency medicines and life-saving equipment were not in line with Resuscitation Council UK standards.
• The systems to identify and manage risk required improvement.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures. With the exception of DBS checks and obtaining references.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider asked staff and patients for feedback about the services they provided.
• The provider had systems to deal with complaints positively and efficiently.
• The governance arrangements required improvement.

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 regulation 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 practice’s systems for environmental cleaning taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.

• Review the practice’s referral procedures to ensure referrals are monitored and dealt with promptly.

• 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.

We found the reception area and waiting room was clean and bright. There was a range of leaflets and posters provided and details on oral hygiene and nutrition. There were some dental products on sale. Information about the cost of each treatment band was displayed.

We observed the receptionist gave patients a pleasant welcome on arrival and spoke with people on the telephone in a polite and respectful manner.

There was a portable ramp available for patients who used wheelchairs and the practice manager told us patients with limited mobility would be treated in one of the downstairs surgeries.

Patients we spoke with told us, “Everything is fine. I have no complaints about the service I receive”. One person told us the, “The care and treatment is excellent. The staff are kind, supportive, considerate and respectful”. One person described the environment as ‘Pristine’. We spoke with a very young patient who had visited the dentist who told us,” I have been brave and have got a sticker badge from the lady”. Patients told us that all treatment required was explained fully to them and they were given time to think about whether to go a head with the treatment or not.

Treatment records were maintained both in electronically and paper records. We sampled four patient records. We saw that information had been updated following each persons treatment and a medical history was updated at every visit.