We carried out this announced inspection on 17 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

Briarmeads Dental Practice is in Oadby, a small town in Leicestershire and three miles south east of Leicester city centre. It provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Free public car parking is available directly in front of the practice.

The dental team includes five dentists (including a foundation dentist), six dental nurses, three trainee dental nurses, one dental hygiene therapist, three receptionists and a practice manager. The practice has three treatment rooms, all on ground floor level.

The practice is an approved training practice for newly qualified foundation dentists. One of the partners is a trainer and has trained dentists since 2001.

The practice is owned by a partnership 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 Briarmeads Dental Practice is one of the two partners.

The practice is undergoing extensive renovation to expand the premises. Two more surgeries as well as new stock and laboratory rooms and a second disabled access toilet are being installed. At the time of the inspection, the practice had a waiting list of new patients seeking to register. The practice will be able to accommodate these patients following completion of the building works.

On the day of inspection, we collected 48 CQC comment cards filled in by patients.

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

The practice is open: Monday to Thursday from 8am to 7.30pm and Friday from 8am to 5.30pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance. Audits were undertaken annually and not six monthly as recommended in guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had most systems to help them manage risk to patients and staff. We noted exceptions in relation to managing all the risks presented by fire and a gas safety check was overdue for completion. Action was taken in relation to the gas safety check immediately after the inspection.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures; we noted that references were not held on two staffs’ files we looked at. A reference for one of the staff members was located after the day.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs. Patients experiencing dental pain were seen by a dentist within 24 hours.
• Training and development were at the forefront of this practice. The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• 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, the frequency of audit undertaken and water temperature testing when undertaking manual cleaning.
• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Ensure all areas of the premises are fit for the purpose for which they are being used. In particular, complete fixed wiring testing of the premises.

• Review staff awareness of the requirements of Gillick competence and the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities and how it relates to their role.

We spoke with two people following their consultation or treatment and asked them if their treatment options had been explained to them in a way they understood. They told us treatment options and fees payable (where applicable), had been explained and they had made an informed decision about whether to go ahead with treatment.

Peoples’ comments included: - “I come regularly and they keep my teeth in excellent condition”, “it’s really good, my dentist is excellent” and “they explained what would happen at each stage”.

The service undertook quarterly audits to confirm continued compliance with decontamination regulations and infection prevention best practice. We looked at these audits and saw that the service was meeting the recommended standards.

People can be reassured that there were effective recruitment and selection processes in place.

The service undertook patient satisfaction surveys every 6 months. We looked at the outcome of the most recent surveys and saw the results were positive. Comments included: - ‘lovely, friendly service – explained fully, best dentist I’ve been to’ and ‘everything is of a very high standard as usual’.

We found the provider was compliant with the essential standards of quality and safety that we inspected.