We carried out this announced inspection on 18 January 2019 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

Tollgate Family Dental Centre is in Osbaston, a small village in the Hinckley and Bosworth district of Leicestershire. It provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available in the practice’s own car park.

The dental team includes two dentists, two dental nurses (including one who is a trainee), two receptionists and a practice manager. The practice has three treatment rooms, one of which is not currently in use and a separate decontamination facility, all on ground floor level.

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 Tollgate Family Dental Centre is one of the partners.

On the day of inspection, we collected 16 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, one dental nurse, one receptionist, the practice manager and the clinical quality and care manager who was based at the provider’s head office.

We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 6pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider 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 to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures that reflected legislative requirements. We found that references for one of the dentists were not held on their file.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• We saw evidence that the dentists justified and graded on the radiographs they took, although we found that they were not always reported on.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement. The practice had been awarded with the Investors in People gold accreditation and had held this for five years.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider had systems to deal with complaints, although none had been received within the previous 12 months.
• The provider had suitable information governance arrangements.

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

• Review the practice’s protocols for recording in the patients’ dental care records or elsewhere the reason for taking X-rays, a report on the findings and the quality of the image in compliance with Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.

We spoke with five patients, two representatives of patients and three staff. We also reviewed five electronic dental records and two staff files.

The patients told us that their treatment had been discussed and that they were able to make an informed decision about their treatment. One patient told us:” All the options and the risk and benefits were explained. The dentist also explained what to expect after the procedure was completed”.

One patient told us:” I have such confidence in my dentist and all the staff here”. All the people we spoke with told us their medical and medication history was always reviewed before every appointment and changes made where necessary.

We noted very detailed daily and shut down records were kept on the general environment and clinical areas. The cleaning schedules we saw evidenced that treatment rooms had been disinfected and cleaned, including the frequency and detail of the tasks performed.

The staff files we looked at showed staff undertook an induction programme when commencing their employment, followed a continuous professional development programme, which included an extensive range of training.

We viewed a wide range of audits and risk assessments and confirmed they were carried out on a regular basis. We noted the audits carried out in 2013 were on record keeping, various clinical procedures, serious events and infection control and decontamination.