We carried out this announced inspection on 19 February 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 this practice was not 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 not providing well-led care in accordance with the relevant regulations.

Background

Townley Dental Care is based in Upwell and offers private treatment to about 1500 patients. The dental team is small, consisting of one dentist, two dental nurses and receptionist. There is one treatment room. The practice is sited within the local health centre and shares some of its facilities.

There is level access for people who use wheelchairs and those with pushchairs and a car park with specific spaces for patients with limited mobility.

The practice opens Mondays, Tuesdays and Thursdays from 8am to 5pm; on Wednesdays from 8.30am to 4pm, and on Fridays from 8am to 12 noon.

The practice is owned by an individual who is the principal dentist there. He has 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 24 CQC comment cards filled in by patients and spoke with another thee patients.

During the inspection we spoke with the dentist, both nurses and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Staff treated patients with dignity and respect, and we received many positive comments from patients about the caring and empathetic nature of the dentist and nurses.

• There were suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.

• Patients’ complaints were dealt with positively and efficiently.
• Staff felt involved and supported and worked well as a team
• Recruitment procedures were not robust
• Dental care records were not maintained in line with guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.
• Medicines were not managed or prescribed according to national guidance.
• Some of the practice’s infection control procedures did not comply with national guidance
• Systems to ensure good governance were limited.

We identified regulations the provider was not meeting. He must:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was not meeting are at the end of this report.

People told us they were very happy with the services provided by Townley Dental Centre. We examined evidence which demonstrated to us that before people received any care or treatment, they were asked for their consent. We saw that detailed plans of care were provided to people to help them make their own informed decisions about the treatment they would require.

We saw that people were involved in the planning of their own treatment at the surgery and that people were consulted about the treatment options available to them. People were informed of the risks and benefits of each treatment option suggested.

We saw that there were effective systems in place to reduce the risk and spread of infection at the surgery.

Staff were supported to be able to offer appropriate care and support to people using services at Townley Dental Centre.

There was an effective complaints policy in place. People were made aware about how to make a complaint if they felt they needed to.