We carried out this announced inspection on 20 September 2017 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.

We told the NHS England area team that we were inspecting the practice. They did not provide any information.

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

Dedham Dental Surgery is in Dedham and provides NHS and private dental treatments, (approximately 60% NHS and 40% private) to patients of all ages.

There is no access for patients who use wheelchairs or pushchairs at the practice due to the age and design of the premises. Car parking spaces, including those for patients with disabled badges, are available in a car park approximately 500 yards from the practice. There is some two hour time limited parking on the high street near the practice.

The dental team includes two dentists, two dental nurses, one dental hygienist and one receptionist. The practice has two treatment rooms, both situated on the first floor of a timber framed listed building in Dedham and accessed via a narrow U shaped or dog legged staircase.

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. At the time of the inspection the practice did not have a registered manager in post. We spoke with the operations manager prior to our inspection who confirmed a new practice manager/registered manager would be joining the practice in early October. In the time prior to this a practice manager from another practice within the company group was supporting the practice and attended the practice along with the CQC lead for the company during the inspection.

On the day of inspection we collected 28 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with one dentist, two dental nurses, one receptionist, the CQC lead and the supporting practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday 8.30am to 1pm and from 2pm to 5pm, Tuesday 8am to 1pm and from 2pm to 5pm, Wednesday 8am to 12.30pm and from 1pm to 4.30pm, Thursday from 8am to 1 pm and from 1.30 to 4pm and Friday 8am to 12.30pm. The practice is closed at weekends.

Our key findings were:

• The practice was clean and well maintained. There were no cleaning schedules in place.
• The practice had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk. There was scope to ensure risk assessments were undertaken for clinical staff who worked alone with patients and where no DBS had been undertaken.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures. Induction procedures for new staff were not in place.
• The clinical staff provided patients’ care and treatment in line with current guidelines. However the dentists did not use rubber dam in line with guidance from the British Endodontic Society when providing root canal treatment, putting patients at unnecessary risk.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The practice leadership was in the process of change. Staff told us they felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided. Comments received from patients were wholly positive. Staff appraisals had not been regularly maintained.
• The practice dealt with complaints positively and efficiently. There was scope to ensure verbal complaints were monitored to ensure trends and learning needs were identified.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the training, learning and development needs of individual staff members at appropriate intervals and ensure an effective process is established for the on-going assessment, supervision and appraisal of all staff.
• 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.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.