We carried out this announced inspection on 12 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

White Orchid Dental Clinic is in the Stapleford area of Nottingham and provides 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 which includes space for blue badge holders.

The dental team includes one dentist, one dental hygienist/ practice manager and one qualified dental nurse. The practice has two treatment rooms, both of which are located on the ground floor.

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.

On the day of inspection, we received feedback from 19 patients.

During the inspection we spoke with the practice manager/ dental hygienist. We spoke with the dentist after the inspection on the telephone. 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, with the exception of water temperatures not being 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 water temperature during manual cleaning of dental instruments was not being monitored.
• The appointment system met patients’ needs.
• The practice did not having an induction hearing loop to assist patients who used a hearing aid.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.

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 and recording of water temperatures during the manual cleaning process.

• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010. Particularly those patients who have hearing difficulties.

• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

We spoke with two patients and observed two other, with their consent, attending appointments during our visit.

We found patients were fully involved with their care and treatment and the patients we spoke with told us they had discussions with the dentist before treatment was delivered.

We found patients were spoken to in a polite and calm manner and when asked patients said they were treated with dignity and respect.

We saw the practice offered different payment plans and patients told us they were aware of the cost regarding each option.

We found the practice to be calm and relaxing. Patients were complimentary regarding the staff and said they were made to feel welcome when they attended the practice.

We found the practice to be clean and well maintained. One patient said they felt the practice was very clean and safe.

We saw information to support patients so they could make a choice of treatment that would be right for them and meet their needs.

We found the reception area was shared with the waiting room and had seating for four people. There was access available for people with disabilities and the surgeries were on the ground floor.