We carried out this announced inspection on 29 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

White House Dental Practice is in Bramhall, Cheshire and provides mainly NHS treatment to adults and children.

The practice is not accessible for people who use wheelchairs and for those with pushchairs, due to the practice being accessed by stairs from the front door. Car parking is available in a pay and display car park a short distance from the practice.

The dental team includes two dentists, two dental nurses, and one dental hygienist. The practice team is led by the practice manager, who is supported by two reception staff. The practice has three treatment rooms and a dedicated decontamination room.

The practice is owned by an individual who is the principal dentist there. 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.

In advance of the inspection, the practice was sent a comment cards box to enable patients to express their views on the service. On the day of inspection, no CQC comment cards had been filled in by patients. We spoke with two patients who told us they were happy with the service.

During the inspection we spoke with two dentists, one dental nurse, one 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 from Monday to Friday, from 8.30am to 1pm and from 2pm to 5.30pm.

Our key findings were:

• The practice appeared clean. There were a number of maintenance issues that required attention.
• The provider had infection control procedures in place. These did not fully reflect 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 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• Some audit was in place to aid improvement at the practice.
• Staff felt involved and supported and worked well as a team.
• The provider asked patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• 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 bagging of instruments including scaler tips and matrix bands and use of a cotton wool dispenser in the surgery.
• Review the practice's waste handling protocols to ensure waste is segregated and disposed of in compliance with the relevant regulations and taking into account the guidance issued in the Health Technical Memorandum 07-01. In particular the security and storage of waste.
• Review the practice's current performance review systems and have an effective process established for the on-going assessment and supervision of all staff.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice protocol for use of a rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice’s protocols to ensure audits of radiography and prescribing are undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

When we visited the White House Dental Practice in July 2013 we were concerned that procedures for cleaning used instruments, checking that staff were suitable and for receiving and responding to complaints did not comply with appropriate regulations and guidance. The provider sent us an action plan stating what they intended to do about this.

We checked to see whether this action had been taken. During the current inspection we talked to the owner and to the practice manager. We looked at the room in which instruments were cleaned. We found that arrangements for cleaning instruments and infection control conformed to the guidelines. The provider showed us their complaints policy with a log of complaints dealt with and had also taken steps to ensure that staff records helped to demonstrate that staff were suitable to work in a dental practice.

When we inspected the White House Dental Practice we spent time talking to the practice manager as well as to both dentists. We spent time looking at care records and at staff files as well as looking at the building and facilities provided at the practice.

We spoke to five people who use the service and spent time in the waiting room so that we looked at reception facilities and the information that was available there.

We found that most people felt that the practice involved them in their care by informing them about choices so that they could make informed decisions. We saw that the practice took full medical histories so that they could plan the most effective care with people and avoid unnecessary risks.

We looked at the practice’s arrangements for decontaminating instruments and found these mainly in accordance with recommendations. However we did not see any audits of these arrangements and so could not be sure that the practice periodically checked this. We looked at staff files and could not see that the necessary enquiries had been made to in order to ensure that staff were suitable to work there.

During our inspection we found that the White House Dental Practice did not have effective systems in place to deal with and respond to complaints.