We carried out this announced inspection on 19 April 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.

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

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces for blue badge holders are available on site. There is also free on-street parking near the practice.

The dental team includes four dentists, four locum dentists, six dental nurses, four trainee dental nurses, two dental hygienists, four receptionists-three of whom perform a dual role as decontamination assistants, and a practice manager. The practice has six treatment rooms.

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 Dental Care Wick was the practice manager.

On the day of inspection we collected nine CQC comment cards filled in by patients and spoke with five other patients.

During the inspection we spoke with three dentists, two dental nurses, one dental hygienist, three receptionists and the practice manager. On the day of the inspection two clinical support managers from the company were also present.

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

The practice is open:

• Monday to Thursday 8am to 8pm
• Friday 8am to 5pm
• Saturday 8.30am to 1.30pm

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance although improvements were underway to address air flow within the decontamination room.
• 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 staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• Improvements were required to ensure that all 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 was providing preventive care and supporting patients to ensure better oral health but improvements were required to ensure that staff were providing care in line with recognised guidelines.
• The appointment system met patients’ needs.
• The practice had effective leadership and a 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 staff dealt with complaints positively and efficiently.
• The practice staff had suitable information governance arrangements.

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

• Review the practice’s ventilation system, in particular having consideration for the quality and control of airflow within the decontamination room; taking into account the guidelines issued by the Department of the Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Review staff awareness of the requirements of the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account the guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’
• Review the practice's protocols for patient assessments and ensure they are in compliance with current legislation and take into account relevant nationally recognised evidence-based guidance.

We spoke with six people on the day of our visit, who were all complimentary about the care that they received at Apex Dental Care Wick.

People told us that they were involved in decisions that were made about their care, and that they understood the choices available to them because the dentists at the practice took time to explain treatments to them.

One person said, "I have been coming here for years and have never had a reason to complain".

Another person told us, "The staff here are always kind and friendly, they make you feel like they care".

We found that the practice provided clear information for people to make informed choices about their care. We found that the practice had clear procedures to ensure that peoples safety and welfare were protected.