We carried out this announced inspection on 22 August 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

Advent Dental Surgery is in Chelmsford, Essex and provides NHS and private treatment to adults and children.

There is some level access for people who use wheelchairs and those with pushchairs.. Patients with reduced mobility are referred to the sister practice further down the road. Car parking spaces are available outside the practice

The dental team includes two dentists, three dental nurses, one dental hygienist, two receptionists and one practice manager. The practice has two treatment rooms.

The practice is owned by an individual who is the registered manager 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 21 CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with the registered manager, two dental nurses, one dental hygienist and the practice manager. There were no dentists on the premises on the day of inspection. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Friday from 9am to 5pm. We were told the practice often opens Saturday and Sunday mornings from 9am to 12.30pm to support out of hours patients.

Our key findings were:

• We received positive comments from patients about the dental care they received and the staff who delivered it.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of ambubags, clear face masks and non-portable suction. Fridge temperatures were not monitored. Following the inspection, the provider took immediate action to replace equipment and put systems in place to ensure safe storage of medicines.
• The practice had infection control procedures which reflected published guidance. Some necessary improvements were highlighted and these were actioned swiftly. A Legionella risk assessment had not been undertaken.
• Staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• 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. Not all staff fully understood their responsibilities under the Mental Capacity Act 2005.
• The practice was providing preventive care and supporting patients to ensure better oral health. Dental care records we reviewed confirmed the dentists assessed patients’ treatment needs in line with recognised guidance. Although there was a lack of detail regarding any discussions with the patient.
• The practice had staff recruitment procedures but some improvements were required.
• The appointment system met patients’ needs.
• The provider had some risk assessments to minimise the risk that can be caused from substances that are hazardous to health. There was no evidence to confirm these had been regularly reviewed to confirm they were still appropriate and there were no data safety sheets available for products used by the practice cleaner.
• Staff had not undertaken fire drills.
• Staff felt involved and supported and worked well as a team.
• Patients commented that the practice building was tired and a bit dismal, there were damaged work surfaces in treatment rooms, a damaged chair and door latch in one treatment room and a cracked floor in the decontamination room.
• The practice asked staff and patients for feedback about the services they provided.
• The practice staff had suitable information governance arrangements.

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

• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.

• 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 undertaking bi-annual infection control auditing, reviewing the process for manual cleaning of instruments, the storage of equipment and hand washing for decontamination processes.

• Review the practice's Legionella risk assessment and implement any recommended actions identified, 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.’

• Review the suitability of the premises and ensure all areas are clean and fit for the purpose for which they are being used. In particular damaged areas of the practice including the cracks in the decontamination room floor, broken door latches and damaged and worn work surfaces in treatment rooms.

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

• Review the practice's policies and procedures for obtaining patient consent to care and treatment to ensure they are in compliance with legislation, take into account relevant guidance, and staff follow them.