We carried out this announced inspection on 22 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

The Dutch Barton Dental Practice is in the centre of Bradford-on Avon and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking is available in the nearby public car parks.

The dental team includes four dentists, five dental nurses, three dental hygienists, one dental hygiene therapist, a practice manager and three receptionists. The practice has four treatment rooms.

The practice is owned by an individual who is 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. The responsibilities are shared with the expense sharing partner who is also registered as an individual provider at this practice.

On the day of inspection we collected 21 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with two dentists, three dental nurses, one dental hygiene therapist, two receptionists 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 & Tuesday 08.30am – 7.00pm
• Wednesday 08.30am – 6.00pm
• Thursday 08.00am – 5.00pm
• Friday 08.00am – 4.00pm
• Closed at weekends
• Out of hour’s information displayed on website and via telephone answering service.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• 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. Not all staff had completed training to the required level.
• The practice had satisfactory staff recruitment procedures for employed and agency staff.
• 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 a culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• 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 practice protocols for medicines management and ensure all medicines are stored and dispensed safely and securely and include all the required information.
• Review the fire safety risk assessment and ensure the ongoing fire safety management is effective. In particular with regard to the fire safety risks and storage of dental models and cardboard. Also review staffs’ awareness and training relating to the management of fire.
• Review the practice recruitment policy and procedures with particular regard to the Disclosure and Barring service checks.

People we talked with at The Dutch Barton Dental Practice said they received safe and quality care. They were able to make informed decisions and no examination or treatment was carried out without their valid consent. We were told staff were professional but also relaxed and put people at ease. People said they understood why certain treatment was in their best interests and did not feel they were pressurised to make quick or unwise decisions.

One patient said: "the service meets my needs very well. Everybody is polite, friendly and helpful." Another said: "I really like this practice. I cannot fault it here at all."

We found the dentists and hygienist we met knew how to gain valid consent from people. They knew how to treat people who did not have the capacity to give valid consent. The practice knew about gaining consent from children and when children could make their own decisions.

People's medical history was recorded and checked at each appointment. The practice had equipment for medical emergencies and staff were trained to use it. People's records were confidential and stored securely. The dentists were able to tell us about protecting people from abuse and how they would report their suspicions. Staff were trained and supported in their roles.

Infection control, cross-infection and decontamination routines were understood and safely carried out. Some arrangements for hand-washing and regular audit routines needed addressing.