We carried out this announced inspection on 8 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

Yew Tree Dental Care is in South Yardley and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available near the practice. There are no dedicated spaces for blue badge holders but staff told us that patients with mobility issues could park on the practice’s driveway.

The dental team includes four dentists, six dental nurses (two of whom are currently on maternity leave) and three receptionists. The practice has three treatment rooms.

The practice is owned by a partnership 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. The registered manager at Yew Tree Dental Care is the senior partner.

On the day of inspection, we collected 21 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, two dental nurses and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Thursday: 9am to 5pm

Friday: 9am to 4pm

Saturday: 9am to 12:30pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected 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. We identified several areas that required improvements and staff acted promptly to resolve these.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Not all staff had completed safeguarding training to the recommended level.
• The provider had staff recruitment procedures which reflected current legislation. However, we found there was no complete evidence held at the practice of immunity to Hepatitis B for two staff members.
• 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.
• We identified some necessary improvements relating to the governance processes at the practice.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and 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 practice's Legionella risk assessment and implement any recommended actions, 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, ensuring that the water temperatures are within the recommended parameters and ensuring they have eliminated any additional risks such as redundant pipework.
• Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.
• Review the practice’s protocols to ensure audits have documented learning points and the resulting improvements can be demonstrated.

During our last inspection in September 2013 we found that the system for recruiting staff was not robust. This visit to the surgery was announced to ensure that we had the opportunity to speak to the registered manager and review the recruitment process.

We looked at the recruitment policy, spoke with the registered manager and reviewed the personnel files of staff employed at Yew Tree Surgery. We found that the required documentation was in place. This included references and employment history.

During our inspection we spoke with the manager / dentist, two other dentists, three dental nurses and one other member of staff. We looked at the clinical records for seven people who used the dental practice and observed four treatments. We later spoke with eleven people who used the dental practice.

We saw that people's privacy and dignity was maintained. One person told us, "Staff always close the door. They also provide me with an apron and protective glasses during treatment."

People told us that treatment options and any costs were discussed with them before they agreed to any treatment. This meant people were aware of what was involved. One person told us, "The dentist is very good, they always explain things to me. I would recommend them."

We saw processes were in place to minimise the risk of infection. People we spoke with had no concerns about general cleanliness.

We saw that staff were qualified for their roles. One staff member told us, "I really enjoy my job role and find it rewarding." However, we found that pre-employment checks were not always completed as required.

We saw that processes were in place to monitor the quality of service and identify improvements where needed.