We carried out this announced inspection on 21 November 2018 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 service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

Background

The domiciliary dental service is based in Nottinghamshire and provides a dental service to patients who are not able to visit a dental practice. For example patients who are housebound or residents living in care homes. The service mostly provides a denture service. The service provides only NHS dental treatment to adults.

The dental team consists of the dentist.

The service is owned by an individual who is the dentist. 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.

Following the inspection, we received feedback from five care home managers about the service provided.

During the inspection we spoke with the provider who is the principal dentist. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open by arrangement through the provider.

Our key findings were:

• The provider knew how to deal with emergencies. Appropriate medicines and the recommended life-saving equipment were available.
• The service had systems to help them manage risk.
• The service had suitable safeguarding processes and the provider knew their responsibilities for safeguarding adults and children.
• The provider provided patients’ care and treatment in line with current guidelines.
• The provider treated patients with dignity and respect and took care to protect their privacy and personal information.
• The service was providing preventive care and supporting patients to ensure better oral health.
• The provider did not have a certificate to demonstrate they had immunity to Hepatitis B.
• The appointment system met patients’ needs.

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.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we observed one person receive some treatment. We spoke with the dentist and a member of staff from the care home where the patient lived and received some treatment. We also spoke with care staff from three other care homes the dentist visited. We looked at some of the records kept by the dentist and their policies and procedures file.

We found patients gave consent to their treatment and this met their needs. We asked a patient if they were happy with the treatment they had received and they made a “thumbs up” sign. We found the provider followed practices designed to protect patients from acquiring an infection, and they assessed and monitored the quality of the service they provided.