We carried out this announced inspection on 10 May 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 dental inspector.

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 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

Concordia Dental Healthcare is in East Grinstead and provides private treatment to adults and children.

There is no level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available in and near the practice. There is a local bus service near to the practice

The dental team includes 1 dentist, 2 dental nurses, 1 dental hygienist, 1 trainee dental nurse, 1 adaption dental hygienist in the process of registering with the GDC, 2 receptionists and 1 registered manager who is also counted as 1 of the dental nurses and 1 of the receptionists. The practice has 2 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 Concordia Dental Healthcare is Ms Ann King.

On the day of inspection, we collected seven CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with 1 dentist, 1 dental nurse, 1 dental hygienist, 1 trainee dental nurse and the registered manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had some infection control procedures which reflected published guidance.
• Staff knew how to deal with some emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had some systems to help them manage risk to patients and staff.
• The provider did not have suitable safeguarding processes and staff were not aware of their responsibilities for safeguarding vulnerable adults and children.
• The provider did not have 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had some effective leadership.
• 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 some information governance arrangements.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

• There were areas where the provider could make improvements. They should:
• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review staff training to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Review the practice's current performance review systems and have an effective process established for the on-going assessment and supervision of all staff.
• 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 protocol and staff awareness of their responsibilities in relation to the duty of candour to ensure compliance with The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.
• Review the availability of an interpreter service for patients who do not speak English as their first language.
• 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.
• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice protocol and staff awareness of their responsibilities in relation to General Data Protection Regulation (GDPR) requirements.

We spoke with four patients who used the service. They were all happy with the care and treatment that they had received. One patient said about the practice, “It’s first class.” Another said, “It’s very good.”

All of the patients we spoke with said the dentists clearly explained the treatment options available to them and the risks and benefits involved. They said they always knew how much their treatment would cost and were given a written treatment plan.

The practice had policies and procedures in place for safeguarding vulnerable adults and children. All staff had received training on safeguarding and understood their roles and responsibilities in relation to this. This meant that patients who used the service were protected from the risk of abuse.

The practice had effective policies and procedures in place for the decontamination of instruments and controlling the risk of infection. We observed that the treatment rooms in the practice were clean and hygienic. One patient said, “It’s spotlessly clean.”