We carried out this announced inspection on 2 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 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

Eastfield Dental Centre is located in the city of Leicester and provides NHS and private treatment to adults and children.

There is stepped access to the premises; it is not suitable for people who use wheelchairs and those with pushchairs. Free unlimited stay car parking is available on the street directly outside the practice.

The dental team includes three dentists, two dental nurses, one dental hygienist and one receptionist. One of the dental nurses also acts as the practice manager. The practice has two treatment rooms; both are on ground 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 13 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, two dental nurses (including the dental nurse who worked as practice manager) and the receptionist. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday from 9am to 5pm, Wednesday from 8.30am to 5pm, Thursday from 9am to 2.30pm, Friday from 9am to 1pm. Appointments were also available with the hygienist on Saturdays.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Most appropriate medicines and life-saving equipment were available. The practice did not hold sufficient quantities of adrenaline to enable them to repeat the dose. They did not have an adult oxygen face mask with reservoir and tubing.
• The practice had some systems to help them manage risk to patients and staff. We found exceptions which included traditional sharps being used and not ensuring that five yearly fixed wiring testing and autoclave servicing had been carried out.
• We saw documentation to show that dentists had received training in safeguarding. Two members of the clinical team had not completed safeguarding to level two at the point of inspection. Evidence was provided to show that one member of the team had completed this after the inspection had taken place.
• The provider did not demonstrate that they had thorough staff recruitment procedures. We did not see references or other evidence of satisfactory conduct in previous employment in the files we examined.
• 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.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice did not demonstrate that they had effective leadership or a culture of continuous improvement.
• Staff who we met supported each other and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider had a system to deal with complaints; the practice told us that no complaints had been received within the past 12 months.
• Governance arrangements required review.

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.

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

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

• Review the practice’s sharps procedures to ensure the practice is in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
• Review staff awareness of Gillick competency and ensure all staff are aware of their responsibilities in relation to this.