We carried out this unannounced inspection on 15 February 2019 and a further announced inspection on the 20 February 2019 (which was a continuation of the inspection process) under Section 60 of the Health and Social Care Act 2008 in response to information of concern, and 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 and a second CQC inspector.

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 not 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 not providing well-led care in accordance with the relevant regulations.

Background

300 Great Western Street (known locally as Rusholme Dental Practice) is in Rusholme, Manchester and provides NHS and private treatment to adults and children.

There is level access to the ground floor reception and surgeries for people who use wheelchairs and those with pushchairs. On street parking is available near the practice.

The dental team includes three dentists including a foundation dentist, 13 dental nurses (eight of which are trainees), a dental hygienist, two dental hygiene therapists (one of which is a foundation therapist), two receptionists and a practice manager. The practice has four treatment rooms.

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 collected one CQC comment card filled in by a patient.

During the inspection we spoke with the dentists including the foundation dentist, dental nurses, the dental hygiene therapist, the foundation hygiene therapist, a 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: Monday to Friday 9am to 1pm and 2pm to 5pm.

Our key findings were:

• The premises were clean and well maintained, with the exception of some areas which were dusty. Environmental cleaning could be improved.
• The provider had infection control procedures which reflected published guidance with the exception of the processes for manually cleaning instruments.
• Staff did not all know how to deal with emergencies. Immediate action was needed to make appropriate medicines and life-saving equipment available.
• The practice did not have effective systems to help them identify and manage risk to patients and staff.
• Improvements were needed to the safeguarding processes. The practice did not ensure that staff were up to date with training. They knew their responsibilities to report any safeguarding concerns.
• The provider did not have 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.
• Staff provided preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• 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 systems to document and deal with complaints required improvement.
• The provider did not have suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Act in accordance with the Duty of Candour.

Full details of the regulations the provider is not meeting are at the end of this report.

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

• Review the availability of an interpreter service for patients who do not speak English as their first language.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• 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 arrangements for transporting instruments, the illuminated magnification device and standards of environmental cleaning).