We carried out this announced inspection on 2 October 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

The Dental Practice is a well-established practice based in Kings Lynn that provides private treatment. The dental team include two dentists, a practice manager and three dental nurses. There are two treatment rooms. There is ramp access for people who use wheelchairs and those with pushchairs. Car parking spaces, including some for blue badge holders, are available near the practice.

The practice opens on Mondays to Thursdays from 8.45 am to 5.30 pm, and on Fridays from 8.45 am to 1 pm.

The practice is owned by an individual who is the principal dentist. He has 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 13 CQC comment cards completed by patients, and spoke with another two. We spoke with both dentists and two nurses.

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, professional and high-quality service.

• The practice had effective systems to help ensure patient safety. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control, and managing radiation risk.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• Patients received their care and treatment from well supported staff, who enjoyed their work.

• Members of the dental team were up-to-date with their continuing professional development and were supported to meet the requirements of their professional registration.

• Patients’ complaints were taken seriously, managed effectively and used as a tool to improve the service.

• The practice asked staff and patients for feedback about the services they provided. Staff felt involved and worked well as a team.

• Recommendations from the practice’s legionella risk assessment had not been implemented and the fire risk assessment had not identified all the risks.

• Not all dentists routinely used rubber dams as recommended by the British Endodontic Society

• The fridge temperature was not monitored daily to ensure it operated correctly.

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

• Review the practices’ current Legionella risk assessment and implement the required actions taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’

• Review the practice's protocols for monitoring and recording the fridge temperature to ensure that medicines and dental care products are being stored in line with the manufacturer’s guidance.

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• Review the fire safety assessment to ensure all risks are identified, that oxygen cylinders are signposted and that fixed wiring testing is undertaken.

• 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.

All of the five patients with whom we spoke gave us positive feedback about the practice. One of them said, “I’ve been using the practice for a number of years and don’t have any complaints because the treatment is very good.”

Patients thought that they had been given enough information about their treatment and the charges that applied.

Records showed that dental care had been based on an assessment of clinical need and that it had been delivered in a reliable way.

We saw that there were good standards of hygiene in the practice and we noted that staff were knowledgeable about their roles in relation to infection control and other key measures.

Records showed that quality checks had been completed to help ensure that good standards of service were maintained. Patients said there was an open atmosphere in the practice that enabled them to make a complaint and suggest improvements. This meant the provider could take their views into account when reviewing the quality of the service provided for patients.