We carried out this announced inspection on 24 January 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 CQC inspector and 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 not providing well-led care in accordance with the relevant regulations.

Background

DentalSpa25 is in Weston Super Mare and provides private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes two dentists, one dental nurse and three receptionists. 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 56 CQC comment cards filled in by patients.

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

The practice is open:

Monday to Friday 9am to 5.30pm

Saturday/Sunday by arrangement

Our key findings were:

• The practice appeared clean and maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and most life-saving equipment were available.
• The practice had some systems to help them manage risk to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The practice was using a dental laser but not in line with guidance
• The practice fire risk assessment did not include the dental laser and had not had been completed by a competent person.
• The clinical staff provided patients’ care and treatment mostly in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs. Staff felt involved and supported and worked well as a team.
• The practice asked patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable 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.

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

We inspected this service because we found aspects of the service which required improvement during our last inspection on 31 October 2013. We found improvements had been made to the service.

The practice provides general and cosmetic dental services to private patients. During our inspection we spoke with six patients about their experiences of using the service; these people made positive comments about the practice and the dental care they received. One patient told us, “The staff are extremely friendly and always remind me about my appointments”, whilst another patient told us, “The treatment I’ve received has been very good and the dentist is very kind.” Other comments included, “I’m so pleased with my dental treatment here” and “the treatment continues to have the desired effect three months later.”

We saw patients were greeted politely and that they received their examinations in private. We asked patients how they were involved in their treatment planning and whether they were informed about what the treatment might involve. Patients told us how the dentists involved them at all times, and gave them sufficient information to make decisions and choices about their treatment. Information about the costs of treatment and the services provided were available in the surgery and on the practices website. We saw treatment was provided in line with the patient’s treatment plan.

We looked at the consultation rooms and other areas of the practice and were satisfied people received safe and effective treatment in a clean environment. Processes were in place to ensure hygiene standards were maintained. We met and spoke with the all the staff working in the practice during our inspection and checked they understood their responsibilities in relation to patient care and the cleanliness of the practice. We found all staff to be knowledgeable and engaged in maintaining appropriate patient care and cleanliness throughout the practice.

We spoke with four people who used the practice to gain their views and experience of the service. People spoken with were very happy with the treatment received when they visited DentalSpa 25. One person said “Gloria is a breath of fresh air; I have waited 82 years for a dentist like her”. People told us that they would and had recommended the dentist to other people because of their satisfaction with the service received.

People told us they could express their views and make informed decisions about their treatment. We read four individual dental treatment records. These showed what treatment was provided and any oral health advice given.

Suitable arrangements were not in place to deal with medical emergencies. This was because staff were insufficiently trained, some of the emergency equipment was not available and the medicines were not stored together with the emergency equipment.

We saw there was a good dirty to clean flow for cleaning and sterilising dental equipment to minimise the risk of people acquiring an infection. However, the practice had not carried out essential checks to ensure they were meeting the necessary standards. We found some areas for improvement that could have been identified through checking their infection control processes.

Staff were supported by the provider to carry out their role to meet people’s needs to an appropriate standard.