We carried out this announced inspection on 5 July 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

Unity Millhouse Dental Practice is in Belper in Derbyshire and provides both NHS and private dental treatment to adults and children.

There is level access into the practice, this is of benefit for people who use wheelchairs and those with pushchairs. There is a car park outside the practice.

The dental team includes three dentists, one oral surgeon, one dental hygienist, four qualified dental nurses, two trainee dental nurses and one practice manager. The practice has three treatment rooms, all of which are located on the ground floor.

The practice is owned by a company 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. At the time of the inspection the practice did not have a registered manager in post.

On the day of inspection, we received feedback from seven patients.

During the inspection we spoke with one dentist, three dental nurses and a manager from the parent organisation. We looked at practice policies and procedures and other records about how the service is managed.

The practice has flexible opening hours and can be open: Monday to Friday: 8.30am to 5.30pm. The practice is closed on Saturday and Sunday.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance, although the water temperature was not being monitored or recorded during the manual cleaning process.
• 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.
• 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 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 provided conscious sedation on an occasional basis. This was completed in line with national guidance and staff were experienced and had received the necessary training to complete this procedure safely.

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

• 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 the monitoring of water temperatures during the manual cleaning process.

• Review the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular the layout of the decontamination room.

People we spoke with told us they were involved in decisions about their care and treatment options. One person told us "I didn't realise there were options for me other than losing my teeth, but the dentists here explain and offer different treatments".

People told us they felt the practice delivered care and treatment in a way that met their needs and felt safe when they had treatment. One person told us "I feel so safe here that I fell asleep during root canal surgery".

Staff could give us examples of types of abuse and possible signs of abuse. They were also aware of the reporting procedure for safeguarding issues.

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

The provider has effective recruitment and selection procedures in place and carries out relevant checks when they employ staff.

The provider had clear systems in place to obtain feedback from all persons involved in the service as well as auditing their own service