We carried out this announced inspection on 12 June 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

Thornton Dental Practice is in the village of Thornton, Liverpool and provides NHS treatment to adults and children. A small amount of private work is also provided.

There is level access to the reception and waiting area and to the surgery room at the front of the building for people who use wheelchairs and those with pushchairs. There is some car parking available outside the practice. There are no designated parking spaces for blue badge holders.

The dental team includes three dentists, three dental nurses and a receptionist. The practice manager is also a dental nurse and provides some cover for absences of dental nurses, as and when required. The practice has two 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.

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

During the inspection we spoke with two dentists, two dental nurses, the receptionist 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, 9am to 5pm. The practice is closed at the weekend.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance. We highlighted areas where governance for some processes required improvement.
• 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. Some staff required refresher training in safeguarding.
• The practice had staff recruitment procedures in place.
• 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 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's protocols and procedures to ensure staff are up to date with their mandatory training for example in infection control and safeguarding, and their continuing professional development.
• Review the practice’s infection control procedures and protocols taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’ In particular carrying out temperature checks on water used to manually clean dental instruments.

• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor use.
• Review availability of medicines in the practice to manage medical emergencies taking into account the guidelines issued by the British National Formulary and the General Dental Council, in particular stocks of adrenaline. Review the process to check stocks of emergency equipment to identify whether any items require replacement.
• Review the practice policy on consent to include Gillick competence and ensure all staff are aware of their responsibilities.

We spoke with four patients who had received treatment at the practice on the day of our inspection. We were told they were satisfied with the dental treatment they had received. They said the dentists they saw were considerate and treated them with respect. One patient said "Clear explanations are always given including the charges and options for treatment, today I have been given three options to consider.” Another patient said "It is local and convenient. I have been coming here for twenty years and it is really good. I have never had a problem.”

All the patients we spoke with said it was easy to get an appointment. One person told us how his wife had been referred onto the dental hospital. Another patient said “This is a small practice but it is very clean and the quality of care is very good.”

Patients told us the dentists clearly communicated to them what their treatment options were including any potential side effects. Details about charges were provided before any decisions on treatment were made. This meant that patients were able to make informed decisions about which treatment option was best for them.