We carried out this announced inspection on 1 April 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 not providing well-led care in accordance with the relevant regulations.

Background

Ashby Fields Dental Practice is in Daventry, a town in western Northamptonshire. It provides NHS treatment to patients exempt from payment and private treatment to adults and children.

Services provided include general dental services, implants, orthodontics and cosmetic procedures.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available in a free public car park in front of the premises.

The dental team includes five dentists, three dental nurses, two trainee dental nurses, one dental hygiene therapist and four receptionists, (one of the receptionists also works as a dental nurse).

Two practice managers share administrative duties.

The practice has five treatment rooms; all of which are on ground floor level. The provider has a refurbishment plan for the premises. This includes updates to surgeries, replacement furniture and a new floor in the decontamination room.

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 37 CQC comment cards filled in by patients.

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

The practice is open: Monday from 9am to 6pm, Tuesday, Wednesday and Thursday from 9am to 5.30pm, Friday from 9am to 5pm.

Our key findings were:

• The practice appeared clean and generally well maintained.
• The provider had infection control procedures which reflected published guidance. We identified exceptions as we were not assured that all staff were made aware of and complied with processes regarding dental work being disinfected prior to it being sent to a dental laboratory or before treatment was completed. Not all staff demonstrated they had completed regular update training.
• Staff knew how to deal with emergencies. Appropriate medicines but not all life-saving equipment were available such as oropharyngeal airways and some of the sizes of clear face masks for self-inflating bag. We were told these had been ordered after the day.
• The practice’s systems to help them manage risk to patients and staff required review as some were ineffective. Potential hazards were not mitigated in relation to legionella.
• The provider had safeguarding processes but not all staff were aware of their responsibilities for safeguarding vulnerable adults and children and reporting procedures.
• The provider had staff recruitment procedures. We found these required improvement, particularly in relation to agency staff.
• The clinical staff provided patients’ care and treatment in line with current guidelines. We noted exceptions where guidelines were not always followed.
• 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.
• The provider dealt with complaints positively and efficiently.
• Governance arrangements required strengthening. Not all risks arising from the undertaking of the regulated activities had been suitably identified and mitigated.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

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

• Review the practice’s protocols and procedures for the use of rectangular collimators fitted to X-ray machines to reduce radiation dose to patients.
• Review guidance regarding basic periodontal examination (BPE) from the British Society of Periodontology.
• Review the practice’s protocols for domiciliary visits taking into account the 2009 guidelines published by British Society for Disability and Oral Health in the document “Guidelines for the Delivery of a Domiciliary Oral Healthcare Service”.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

People who use the service told us they were happy with the service. One person told us that they had joined the practice after bad experiences at another and now felt safe. We were told that treatment was efficient and timings for follow up appointments were prompt.

Although people were positive about the care they received we found concerns in relation to arrangements for emergency incidents and infection control.

We did not speak to people who use the service. Instead we reviewed the improvements the provider had made to the equipment that would be used in emergencies and the cleanliness of the practice along with the effectiveness of infection control procedures.