We carried out this announced inspection on 5 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 not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was not 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 not providing well-led care in accordance with the relevant regulations.

Background

Church Street Dental Care is in Littleborough, Lancashire and provides private treatment for adults and children.

There is single step access into the practice. Car parking is available near the practice on local side streets.

The dental team includes the principal dentist, four dental nurses (one of whom is a trainee) and one dental hygienist. The practice has two 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 collected 14 CQC comment cards filled in by patients. All comments received were complimentary about the service being provided.

During the inspection we spoke with the principal dentist, two dental nurses and the dental hygienist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday by appointment only.

Tuesday 10am to 7:30pm, Wednesday 10am to 2:30pm, Thursday 9am to 5pm and Friday 8am to 4pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which could be brought fully in line with guidance.
• Staff knew how to deal with emergencies. The management of the medical emergency kit was not in line with recommended guidance.
• The practice had systems to help them manage risk but improvement was needed.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider’s recruitment procedures could be improved.
• Improvement was required to systems in place to confirm staff immunity.
• Clinical awareness of the National Institute for Clinical Excellence (NICE) and The Faculty of GeneralDental Practice UK (FGDP (UK) was not embedded.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Improvements could be made to delivering preventive care and support to patients to ensure better oral health in line with recommended guidance.
• The appointment system took account of patients’ needs.
• Some areas of leading the practice and managing systems and processes could be improved.
• The practice’s systems for continuous improvement were not effective.
• 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 had systems to deal with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was not meeting are at the end of this report.

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

• Review the practice’s systems for environmental cleaning taking into account the guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices. In particular: the storage of mops.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account guidance issued by the National Institute for Clinical Excellence (NICE).
• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment. In particular: register the use of X-ray equipment as required, with the Health and Safety Executive.

During the visit, we spoke with one person who uses the services. They told us they were asked for both written and verbal consent prior to receiving any treatment on every occasion.

The person we spoke with told us they were very happy with the services provided and had been at the practice for over 20 years. They were happy with the services received. They also told us the dental practice was clean and tidy and looked beautiful.

The person we spoke with told us the staff were very good and explained what they were doing. They had no concerns about the services they received and would speak to the Principal Dentist if they had any concerns.