We carried out this announced inspection on 23 April 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 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

D B Allen Rawtenstall is in Rossendale, Lancashire and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. There is no car parking immediately outside the surgery. A long stay car park is located approximately two minutes’ walk from the practice.

The dental team includes 2 dentists, two dental nurses, two dental hygienists, and one receptionist. The practice has three treatment rooms, two at ground floor level and one at first floor level.

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 26 CQC comment cards filled in by patients. All feedback provided was positive.

During the inspection we spoke with two dentists, one dental nurse, and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open on Monday and Thursday from 8.30am to 5.45pm; on Tuesday from 8.30am to 7pm; on Wednesday from 8.30am to 1pm; and on Friday from 8.30am to 5pm. The practice closes each day for lunch between 1pm and 2pm.

Our key findings were:

• The practice appeared clean and tidy. Clinical areas appeared to be well maintained.
• The provider had infection control procedures in place; these did not fully reflect published guidance. Our observations of staff showed that these were not routinely followed by all.
• Staff knew how to deal with emergencies.
• All appropriate medicines and life-saving equipment was not available, as described in recognised guidance.
• The practices systems to help them manage risk to patients and staff required review.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• Staff recruitment procedures in place did not reflect recognised guidance and legislation.
• 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.
• Leadership was present but required improvement.
• Staff felt involved 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.
• Information governance arrangements required improvement.

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

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

Full details of the regulations the provider 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 systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular, a risk assessment should be conducted in respect of the dental hygienist who routinely works without dental nurse support.

• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice. This should include annual audit to ensure adherence to protocol.

We carried out an announced comprehensive inspection on 23 November 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

Located close to Rawtenstall town centre and close to public transport links, the practice provides private dental care for adults and children. Treatments include general and cosmetic dentistry, including dental implants. There are three surgeries at the practice. Patients who are unable to use the stairs can be seen in the ground floor surgery.

The practice is open Monday 08:30 to 19:00, Tuesday and Thursday 08:30 to 17:25, Wednesday 08:30 to 13:00 and Friday 08:30 to 17:00. It is closed between 13:00 and 14:00 each day for lunch.

The dental team currently comprises two dentists, two dental nurses, a practice manager and a receptionist.

The practice owner is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We reviewed feedback from 49 patients as part of the inspection. Patients were extremely positive about the staff and standard of care provided by the practice. Patients commented that they felt involved in all aspects of their care and found the staff to be helpful, respectful, friendly and were treated in a clean and tidy environment.

Our key findings were:

• The practice was well organised, visibly clean and free from clutter.
• An infection prevention and control policy was in place. We saw the sterilisation procedures followed recommended guidance.
• Systems were in place for recording accidents and significant events
• Practice meetings were used for shared learning, including ‘cascade’ training.
• The practice had a safeguarding policy and staff were aware on how to escalate safeguarding issues for children and adults should the need arise.
• Staff received annual medical emergency training. Equipment for dealing with medical emergencies reflected guidance from the resuscitation council.
• Dental professionals provided treatment in accordance with current professional guidelines.
• Patient feedback was regularly sought and reflected upon.
• Patients could access urgent care when required.
• Dental professionals were maintaining their continued professional development (CPD) in accordance with their professional registration and some of this was achieved through the provision of ‘cascade’ training at the practice.
• A complaints process was in place but the practice had never received a complaint.
• The practice was actively involved in promoting oral health.

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

• Review the practice’s process to ensure the Infection Prevention Society (IPS) audit is completed on a six monthly basis.
• Review the practice’s incident management policy to ensure it captures the full range of incidents that could occur at the practice, including significant events.
• Review the practice recruitment policy and procedures to ensure references for new staff appointed are requested and recorded.
• Review the approach to staff training, including safeguarding training, to ensure it meets mandatory training needs and the Continuing Professional Development needs of staff.

We were told that the staff were "Professional and friendly" and "Welcoming and easy to talk to". We were informed both verbal and written information about any treatment they may require was provided.