We carried out this unannounced inspection on 26 February 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

Brighton Dental Care is in Brighton and provides NHS and private treatment to adults and children.

There is no level access for people who use wheelchairs and those with pushchairs. The practice refers patients who cannot navigate the stairs in the practice to a nearby dental practice with level access.

The dental team includes four dentists, four dental nurses, one student dental nurse, four dental hygienists, three receptionists. The practice has five treatment rooms.

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 did not collect any CQC comment cards filled in by patients as this was an unannounced inspection.

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

The practice is open:

Monday and Tuesday 9am to 7pm

Wednesday, Thursday and Friday 9am to 5pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which needed adjustments to reflect published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff, although some of these needed updating.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children, although the provider had not notified us of a recent safeguarding referral which is a requirement of their registration with us.
• The provider had staff recruitment procedures, but two members of staff had not provided a DBS under schedule 3 of the Health and Social Care Act 2014.
• The clinical staff provided patients’ care and treatment in line with current guidelines.

Staff treated patients with respect and took care to protect their personal information.

• We noted CCTV was present around the practice which included dental treatment rooms.

The location of the CCTV could be improved to ensure patient dignity is respected at all times.

• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• 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 protocols for the use of closed circuit television cameras taking into account the guidelines published by the Information Commissioner's Office.
• Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice, such as DBS checks.
• 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’, storage of dental instruments.
• Consider broadening the scope of audit systems. In particular, by the inclusion of antimicrobial prescribing.

During our inspection we spoke to a total of six staff; two dentists, two dental nurses and two receptionists. We also looked at records to help us understand the needs and views of the patients who used the service. These included a patient satisfaction survey, minutes of staff meetings and the surgery’s complaints log. We also spoke to six patients.

The patients we spoke with told us that they received good dental treatment at this practice. One patient told us, “They have a good manner and are very relaxed. I would recommend them”. A dentist told us, “It is a vibrant and good place to work. We see different cultures, different social statuses and multi-national and diverse patients”. One dental nurse told us, “They are all excellent dentists here. They all want the patients to have the best treatment that they can provide” and “On the whole we are excellent at emergencies and if there is a real problem and we can’t fit them in one of the dentists will usually see them even if it is after hours”.

We found that the practice was following infection control policies and staff demonstrated they had a good understanding of infection control procedures. All the staff we spoke with knew their roles in protecting vulnerable adults and children. The practice had systems in place to assess and continually review the service that it provides and was making improvements where needed.