We carried out this announced inspection on 7 August 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

The Cathedral Street Dental Practice is a well-established practice based in Norwich that provides private treatment to about 2,000 patients. The dental team includes one dentist, two nurses, a hygienist and two receptionists. Another, separately registered, dental practice is based at the same location and shares some of the same staff, costs and facilities with this practice.

The practice opens on Mondays to Thursday from 8 am to 3 pm, on Thursdays from 10.30am to 5pm, and on Fridays from 8am to 3pm.

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 was the dentist.

On the day of inspection, we collected 26 CQC comment cards completed by patients, and spoke with another two. We spoke with the dentist, her nurse and the receptionist. We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring, professional and high-quality service.

• Staff worked very well with patients with special needs and it was clear they were passionate about their oral health. Patients also told us staff were very skilled with their children, allowing for a stress-free visit.

• The practice had effective systems to help ensure patient safety. These included safeguarding children and adults from abuse, maintaining the required standards of infection prevention and control, and responding to medical emergencies.

• Risk assessment was robust and action was taken to protect staff and patients, although the fire assessment needed to be reviewed.

• Patients’ needs were assessed and care was planned and delivered in line with current best practice guidance from the National Institute for Health and Care Excellence (NICE) and other published guidance.

• Patients received their care and treatment from well supported staff, who enjoyed their work.

• Members of the dental team were up-to-date with their continuing professional development and were supported to meet the requirements of their professional registration.

• The practice had effective leadership and a culture of continuous audit and improvement.

• The practice asked staff and patients for feedback about the services they provided. Staff felt involved and worked well as a team.

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

• Review the fire safety risk assessment to ensure all risks are identified and oxygen cylinders are signposted.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

One person said "They explain how my treatment will work for me and reasons for it and I would then sign my consent form".

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person we spoke with told us: "I would recommend this practice to everyone, they are so professional and staff are very patient."

The practice manager who accompanied us during our visit made available all the records we asked to see. They had systems in place to monitor and reduce cross infection, safeguard vulnerable people and attend to any complaints. There was the opportunity for people to air their views through the patient satisfaction survey and/or leave their comments in the suggestion box. We saw that the information gathered was used to improve the quality of care.