We carried out this unannounced inspection on 27 June 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection following the receipt of some concerning information 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They provided information which we took into account.

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

Thorndike Dental Practice is in Rochester and provides NHS and private treatment to patients of all ages.

The practice does not have level access for people who use wheelchairs and pushchairs. Car parking spaces, including spaces for patients with disabled badges, are available near the practice.

The dental team includes seven dentists, Two of which are foundation training dentists and one is an orthodontic specialist, four registered dental nurses, three student nurses, three dental hygienists, a practice manager, a compliance manager, a treatment co-ordinator and two receptionists. The practice has five treatment rooms.

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 Thorndike Dental Practice was the compliance manager.

On this occasion we did not supply CQC comment cards to be filled in by patients as this was an unannounced inspection. However we spoke with four patients over the telephone following our inspection. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, four dental nurses, one dental hygienist, one receptionist, the treatment co-ordinator, the compliance manager 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 and Thursday 9am to 5.30pm

Wednesday 9am to 5.30pm with alternate 9am to 7pm

Friday 8am to 3pm

Saturday 9am to 12pm

Our key findings were:

• The practice was 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 had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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 appointment system met patients’ needs.
• The practice had effective leadership. 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 dealt with complaints positively and efficiently.

We carried out a planned review of the service on the 13 June 2013. We judged the service compliant with Regulations 9, 10, 12, 18, and 19. We judged the service non-compliant with Regulation 11 safeguarding service users from abuse, and Regulation 21 requirements relating to workers. Two compliance actions were made at that time. We asked the provider to send us an action plan, which would tell us in detail what action was being taken to address these areas of non-compliance. We received an action plan from the provider informing us of the action taken to address these areas of non-compliance.

We carried out a responsive follow up review visit on the 27 February 2014, in order to see what improvements had been made and to judge whether the service was compliant with Regulation 11 and Regulation 21. During the visit we spoke with one of the dentists, who was one of the partners at the practice, the practice manager, a dental nurse and the receptionist.

We found that action had been taken to address the areas of non-compliance in that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We also found that a robust recruitment process had been implemented and was in place. This helped to make sure that only people who were deemed as suitable were employed to care for people that used the service.

We visited Thorndyke dental practice and talked with staff, looked at records and spoke with people who used the service. We found that before people received any care or treatment, they were asked for their consent and the dentist acted in accordance with their wishes.

One patient told us, “The dentist explains what the problem is and what they can do about it, I then sign an agreement before treatment begins”, another said, “I sign a consent form when I visit for any treatment before they proceed”.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People who used the service were not fully protected from the risk of abuse, because the provider had not taken reasonable steps to ensure staff had received appropriate training for adult abuse.

There were effective systems in place to reduce the risk of infection.

There were no effective recruitment and selection processes in place.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

People had their comments and complaints listened to and acted on, without the fear that they would be penalised for making a complaint.