We carried out this announced inspection on 8 June 2017 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information for us to take into account.

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

Wigston House Dental Practice is in Wigston, a town in Leicester and provides NHS and private treatment to patients of all ages.

There is a single step at the front entrance of the building. Measures have been taken to enable people who use wheelchairs and pushchairs access to the practice if required. There is some limited car parking at the rear of the premises and free car parking is also available on the street where the practice is based. There is a free public car park within short walking distance.

The dental team includes three dentists (one is a trainee dentist), three dental nurses, one therapist and a receptionist. The practice are currently recruiting for a nurse and receptionist. The practice does not currently employ a practice manager following the staff member leaving in April 2017.

The practice has four treatment rooms with one 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.

The principal dentist is an approved dental trainer for dentists new to general dental practice. The practice currently has one trainee dentist working in the practice.

On the day of inspection we collected 15 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open Monday and Tuesday from 11am to 2.30pm and 3.15pm to 7.15pm, Wednesday and Thursday from 8am to 12pm and 12.45pm to 4pm. On alternating Fridays, the practice is open from 8am to 12pm and 12.45pm to 4pm or 9.30am to 1.15pm and 2pm to 5.45pm. The practice also opens one Saturday per month.

Our key findings were:

• The practice ethos included the provision of high quality dental services to the local community in a professional, friendly and inviting environment.
• There was evidence of some effective leadership. We found areas where management arrangements required strengthening however.
• Staff had been trained to deal with emergencies, but we found the practice did not hold all appropriate medicines and equipment necessary to respond in the event of a medical emergency.
• The practice appeared clean and well maintained.
• Staff knew their responsibilities for safeguarding adults and children living in vulnerable circumstances.
• Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines although we noted exceptions in relation to some record keeping.
• The practice demonstrated awareness of the needs of the local population and took these into account when delivering the service.
• Staff received most training appropriate to their roles and were supported in their continued professional development (CPD) by the practice.
• Staff we spoke with felt supported by the provider and were committed to providing a quality service to their patients.
• The practice asked patients for feedback about the services they provided. Information we obtained from 15 Care Quality Commission cards provided positive feedback. We did not receive any negative feedback about the practice.

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

• Review their governance arrangements to effectively support the management of the service. This should include improvements in policy, procedures and identifying risks involving clinical processes.

• Review the practice’s audit protocols to ensure audits of various aspects of the service, such as dental record keeping, stock checking and infection prevention and control are undertaken at regular intervals to help improve the quality of service. Practice should also ensure, that where appropriate audits have documented learning points and the resulting improvements can be demonstrated.

• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.

• Review staff awareness of Gillick competence and how this relates to their role.

One patient who used the service commented "I am very happy with the service on the whole however on one occasion they referred me but did not update me with result." Another person we spoke with commented, "they are excellent, really nice, they always treat me and my family well." A young patient we spoke with said "I have just been shown how to clean my teeth properly by the dental nurse and they hand out free toothpaste they are really good."

The patients who used the service told us they were satisfied with the quality of service they received. Patients said they were asked about their medical history and about any dental problems. One patient told us “they always ask me to tell them if I have any ongoing medical problems."

We found the practice to be compliant with the regulations we inspected against.