We carried out this announced inspection on 8 March 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.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not have any relevant information to share with us regarding this dental practice.

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

Boston Smiles Centre Care is situated in the centre of Boston in Lincolnshire. The practice provides both private and NHS dental treatment.

The practice has four treatment rooms, all of which are located on the ground floor. There are a number of pay and display car parks close to the practice.

The dental team includes: three dentists, one part time dental hygienist, one qualified dental nurse, two trainee dental nurses, two receptionists and a practice manager.

The practice is owned by an organisation and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have 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 the practice is the owner of the business.

On the day of inspection we received feedback from 52 patients. This information gave us a positive view of the practice.

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

The practice opening hours are: Monday: 8am to 8pm; Tuesday 8am to 6:30pm; Wednesday 8am to 8pm; Thursday 8am to 6:30pm; Friday: 8am to 6:30pm; Saturday: 8:30am to 3pm and alternate Sundays : for emergencies 9am to 12:30pm.

Our key findings were:

• The practice was situated in new premises, so the entire premises had been in use as a dental practice for a little over two months.
• The practice had infection control procedures which followed published guidance.
• The practice asked staff and patients for feedback about the services they provided, and received positive feedback.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice used digital X-rays and rectangular collimation was fitted to all X-ray machines within the practice.
• The practice had systems to help them manage risks in the practice, particularly with regard to health and safety.
• The practice had suitable safeguarding processes. Staff had been trained and 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 measures to protect their privacy and personal information.
• The practice completed regular audits and used the information to make improvements.
• The appointment system met patients’ needs.
• The practice had effective leadership. Staff felt involved and supported and worked well as a team.

We carried out an announced comprehensive inspection on 19 November 2015 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

The practice is situated in the centre of the market town of Boston in Lincolnshire. It is registered to provide primary dental services to NHS patients and also provides private dental treatment for a small number of patients. The property was previously a dental practice and the new owners have modernised it since taking the premises over in July 2015. The practice has three treatment rooms (only two are currently in use), a central decontamination suite and a patient waiting area. There are two pay and display car parks at the front of the practice. The patient areas are on the ground floor of the building and there is easy access to the treatment rooms for patients using wheelchairs and those with limited mobility.

The practice employs two dentists, one dental nurse, two trainee dental nurses and four reception staff. The current owner Ishak Practices Ltd took over the practice in July 2015 and the provider has 11 practices in total. The practice is open Monday to Friday from 8am to 6.30pm and until 8pm Tuesday and Friday. The practice opens Saturday 8.30am to 3pm and alternating Sundays from 9am to 12pm.

The practice manager is also the registered manager of this practice. There is another practice manager at another location that offers support to this practice if necessary. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We viewed seven CQC comment cards that had been left for patients to complete, prior to our visit. All of the comment cards reflected positive comments about the staff and the services provided. Patients commented that the practice was clean and well equipped, they found the staff very friendly and helpful and were happy with the care they received. They said explanations were clear and made the dental experience as comfortable as possible

The practice was providing care which was safe, effective, caring, responsive and well-led in accordance with the relevant regulations.

Our key findings were:

• The practice recorded and analysed significant events and complaints and cascaded learning to staff.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Appropriate medicines and life-saving equipment were readily available and accessible.
• Infection control procedures were in place and staff had access to personal protective equipment.
• Patients’ care and treatment was planned and delivered in line with evidence based guidelines and current legislation.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met the needs of patients and waiting times were kept to a minimum.
• There was an effective complaints system.
• The practice was well-led and staff felt involved and worked as a team.
• Governance systems were effective and clinical and non-clinical audits were used to monitor the quality of services.
• Staff training in Basic life support had been booked for March 2016. The staff we spoke with knew the processes to follow.
• Not all staff had received safeguarding training however the staff we spoke with knew the processes to follow to raise any concerns.
• A rubber dam was not used routinely for root canal treatment.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society
• Review the referral process to ensure patients received care and treatment needed in a timely manner.
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review staff training in relation to safeguarding.