We carried out this announced inspection on 24 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

Advance Dental Clinic is in Chelmsford, Essex and provides private treatment to adults and children.

There is level access at the front of the building for people who use wheelchairs and those with pushchairs. Car parking is available behind the practice with spaces for blue badge holders at the front of the premises.

The dental team includes six dentists, eight dental nurses, one trainee dental nurse, one dental hygienist, one dental hygiene therapist, one receptionist and two practice managers. The practice has six treatment rooms and two decontamination 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 38 CQC comment cards filled in by patients.

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

The practice is open: Monday to Wednesday from 8am to 7pm, Thursday and Friday from 8am to 5pm and Saturday from 9am to 12.30pm.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• The practice appeared clean and well maintained.
• The practice staff had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. A second oxygen cylinder was not available at the practice when undertaking sedation.
• 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.
• Staff recruitment procedures were in place. However not all staff had a record of immunity to Hepatitis B detailed in their records. We noted that references or other evidence of satisfactory conduct in previous employment were not held in two recently recruited staff members files.
• 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 appointment system met patients’ needs. Evening appointments were available until 7 pm on Monday, Tuesday and Wednesday evenings, and Saturdays from 9am to 12.30pm.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the necessity of a second oxygen cylinder where appropriate for the practice's circumstances.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.

People we spoke with during our visit told us they were pleased with the quality of the service. They advised us their dental care and treatment had been fully explained to them and they had agreed to the fees, the care and treatment plan. They told us they had made clear choices about the options of different treatments they had been able to choose from.

One person said, "I have always been treated by all the staff with the utmost respect and consideration. I would not want to go to any other dentist".