We carried out this announced inspection on 5 December 2017 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.

We told the NHS England Cheshire and Merseyside area team that we were inspecting the practice. We did not receive any information of concern from them.

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

Balls Road Dental Practice is in a residential suburb of Birkenhead and provides dental care and treatment to adults and children on an NHS and/or privately funded basis.

There is level access to facilitate entrance to the practice for people who use wheelchairs and for pushchairs at the side of the building. The practice has three treatment rooms. Car parking is available outside the practice and nearby.

The dental team includes three dentists, one of whom is a foundation dentist, two dental hygienists, six dental nurses, one of whom is a trainee, and two receptionists, one of whom is also a dental nurse. The team is supported by a practice manager.

The practice is owned by a partnership and as a condition of registration must have in place a person registered with the Care Quality Commission as the registered manager. Registered managers have a 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 Balls Road Dental Practice is one of the principal dentists.

We received feedback from 37 people during the inspection about the services provided. The feedback provided was positive about the practice.

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

The practice is open:

Monday to Friday 9.00am to 5.00pm

Our key findings were:

• The practice had safeguarding processes in place.
• The practice had infection control procedures in place which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medical emergency medicines and equipment were available.
• 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 appointment system took patients’ needs into account. Dedicated emergency appointments were available.
• The practice had a procedure in place for dealing with complaints.
• The practice had a leadership structure. Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• The practice had systems in place to help them manage risk but sharps risk management was not effective.
• The practice had staff recruitment procedures in place. References were not obtained for new staff.

There were areas where the provider could make improvements and should:

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency.
• Review the practice’s staff safeguarding training ensuring that all staff are aware of their responsibilities.
• Review the practice’s sharps procedures taking into account the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, and review the practice’s system for the investigating and reviewing of accidents with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the protocol for maintaining accurate, complete and detailed records relating to the employment of staff. This includes making appropriate notes of verbal references taken and ensuring references are suitably obtained and recorded.
• Review the availability of an interpreter service for patients who do not communicate in English as their first language.

We spoke to two patients during our visit. Both were happy with the service they received and felt that the practice always informed and involved them in their treatment. Patients were made aware of our visit and were invited to comment. One person used our ‘Have Your Say’ section on our website and commented:

‘I have been registered with this dental practice for some time now and have always found them to be super but I had to write in today. I am aware that services rarely ever get to hear what is good about them; usually people exercise the right to complain, which is their right but in this case, let's have some praise’

‘I started to experience severe dental pain yesterday evening and found it impossible to manage with over the counter analgesia. Fearing an abscess and having suffered the whole evening and throughout the night, I went along to the practice first thing this morning, to be there when it opened, hoping for support. I was taken straight to the waiting room and treated with incredible kindness from the marvellous receptionist and some of the nursing staff. The dentist saw me to assess and numb my jaw with local anaesthetic within minutes. I cannot praise the team enough. Prompt treatment, empathic handling of me as a very distressed patient and quality service provided. This practice has always done a wonderful job of caring for me and my family but they went above and beyond today for someone in extreme pain. Cannot praise them highly enough. I thank you all.’

We were able to see the results of the last quality assurance questionnaires provided to patients in January 2012. All comments were very positive about the service.