We carried out this announced inspection on 26 October 2017 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 Spalding Dental Surgery is located in Spalding, a market town in Lincolnshire and provides private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs by way of a raised ramp. Car parking facilities are available at the practice.

The dental team includes five dentists, seven dental nurses, three dental hygienists, six receptionists, a cleaner, a deputy manager and a practice manager.

The practice is purpose built and has four treatment rooms; three are located on the ground floor.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers 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 registered manager at The Spalding Dental Surgery is one of the three principal dentists.

The provider had plans to extend their premises. We were informed that building work was due to commence in early 2018. The plans included the installation of a laboratory and decontamination room.

On the day of inspection we collected 48 CQC comment cards filled in by patients. This information gave us a positive view of the practice. We did not receive any negative feedback about the practice.

During the inspection we spoke with two dentists, four dental nurses, 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 from 9am to 5.15pm and Tuesday to Friday from 8.30am to 5.15pm.

Our key findings were:

• The practice objectives included the delivery of a high standard of dental treatment in a safe, supportive and caring environment.
• Effective leadership was evident in most areas of the practice. We noted areas where management arrangements required improvement.
• Staff had been trained to deal with emergencies and equipment and appropriate medicines were readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected current published guidance.
• Staff were aware of their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• The practice had adopted processes for the reporting of incidents and accidents. We found that systems required strengthening to ensure that preventative action was always taken and learning outcomes discussed.
• Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The practice demonstrated awareness of some of the needs of the local population and took these into account when delivering the service.
• Patients had access to routine treatment and urgent care when required.
• Staff received training appropriate to their roles and were supported in their continued professional development (CPD) by the practice.
• The practice dealt with complaints efficiently.
• Staff we spoke with felt committed to providing a quality service to their patients.

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

• Ensure that documentation regarding equipment and medicines is held by practice management when services such as sedation are provided by clinical professionals who do not regularly work within the practice.
• Review arrangements regarding the storage of paper records to ensure they are held securely.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.
• Review the use of risk assessments to monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Review the practice's current audit protocols to ensure audits of key aspects of service delivery are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.

Spalding Dental Surgery has five dentists and three dental hygienists. The patients were all private. We spoke with four members of staff, two dentists and two patients.

People told us they were involved in decisions about their care. One person told us, “We[the dentist and the person] talk about options.” Records showed people’s medical history was taken when they registered with the practice and updated at regular intervals.

People told us the dentist wore protective equipment when treating them. One person said, “They give me goggles and a bib and the dentist wears a mask and gloves.” We saw decontamination processes ensured equipment was clean and safe to use. The environment was clean and tidy.

Staff told us they were supported to deliver safe care. Records showed training included infection control, safeguarding vulnerable people and medical emergencies.

We saw there were systems in place to monitor the quality of service people received.