We carried out this announced inspection on 1 March 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

Bupa Lexham Gardens in in Amersham and provides NHS treatment to children and private treatment to patients of all ages.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including one for blue badge holders outside the front of the practice.

The dental team includes two dentists, one dental nurse, one trainee dental nurse, three dental hygienists, one administrator, one receptionist and a practice manager. The practice has four treatment rooms which are all on the ground floor.

The practice is owned by a company 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 Bupa Lexham Gardens is the practice manager.

On the day of our inspection we collected nine CQC comment cards filled in by patients and obtained the views of four other patients.

During the inspection we spoke with two dentists, one nurse, one trainee dental nurse, one hygienist, one receptionist, and the practice manager.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday 8.00am to 8.00pm
• Tuesday 7.30am to 5.00pm
• Wednesday 8.00am to 5.30pm
• Thursday 8.00am to 6.00pm
• Friday 8.00am to 5.00pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected 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.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• 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.
• The practice monitored staff training effectively.
• The practice provided preventive care and supported patients to ensure better oral health.
• Improvements were needed to the fire escape route accessibility and the provision of emergency lighting. We have since been provided evidence to confirm this shortfall is being addressed.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• Improvements were needed to the stock control of medicines, referral tracking, self-employed staff appraisals, audits of patient care records, radiographs and antimicrobial prescribing.

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

• Review the practice's procedures to ensure patient referrals to other dental or health care professionals are received in a timely manner.
• Review and equipment and the practice's system for identifying, disposing and replenishing of out-of-date stock and review protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the and ensure all areas are fit for the purpose for which they are being used. In particular, the loft space.
• 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 manual cleaning of instruments.
• Review the current staffing arrangements to ensure all dental care professionals are adequately supported by a trained member of the dental team when treating patients in a dental setting taking into account the guidance issued by the General Dental Council.
• Review the practice’s protocols to ensure audits of radiography, where appropriate have documented learning points and the resulting improvements can be demonstrated.

We saw that people's consent was obtained before treatment was provided. People were given information on their treatment options so they could make an informed decision around their care. One person told us "They suggest treatment options and I consent by signing my treatment plan." Staff were aware of the Mental Capacity Act (2005) and how this impacted people's ability to consent to treatment.

We saw that people's medical histories were taken into account. New patients were required to fill in a medical history questionnaire and people's medical histories where reviewed regularly. Staff were aware of people's medical history through their internal computer system which flagged people who had medical issues. One person told us "They always ask me how I am and if my medication has changed."

The provider ensured that staff had a working knowledge of safeguarding issues and how to address these when providing care and treatment. Staff had access to relevant policies and guidance around safeguarding and were able to demonstrate how they would escalate any safeguarding concerns. This demonstrated that people's safety and welfare was appropriately met.

Recruitment checks and procedures where in line with the providers policy and legal guidelines. We saw that all staff had appropriate pre-employment checks and their suitability to work was assessed. People could be sure that they were being treated by staff who were qualified and registered with their professional body.