We carried out this announced inspection on 25 May 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 and Healthwatch that we were inspecting the practice. They did not provide any information which we took into account.

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

Eurodental is in Swindon and provides NHS and private treatment to patients of all ages.

There is no level access for people who use wheelchairs and pushchairs but the company will treat patients at their practice in Devizes Road a few minutes’ walk away which has access via a portable ramp. Car parking spaces, including for patients with disabled badges, are available near the practice in a public car park.

The dental team includes four dentists, three dental nurses, two trainee dental nurses, two dental hygienists and two receptionists. The practice has six treatment rooms.

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. The registered manager at Eurodental was the practice manager.

On the day of inspection we collected 39 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 two dentists, two dental nurses and trainee dental nurse, one dental hygienist, one receptionist and the practice manager.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday to Thursday: 8.30am to 5.30pm; Friday 8.30am to 4.30pm, Saturday: Closed, Sunday: Closed

Our key findings were:

• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had thorough staff recruitment procedures.
• 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 had effective leadership. Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.
• The practice was clean and well maintained, although we found some tears in the fabric of two dental chairs.
• The practice had infection control procedures which mainly reflected published guidance, although improvements were required as there was no separate room for the complete end to end decontamination process and we found that it was not possible to complete the process within each surgery.
• The practice radiation protection information was incomplete and we found no rectangular collimator on the X-ray machines in surgeries one and four.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Improvements were required as some staff had not undertaken safeguarding training or the minimum training in child safeguarding.
• The practice had not established a log to track referrals made to external professionals and organisations.
• The clinical staff provided patients’ care and treatment in line with current guidelines, although dental nurses worked with the dentists when they treated patients but not usually dental hygienists.

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

• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD)
• Review the practice’s protocols for maintaining the required radiation protection information in compliance with the Ionising Radiation (Medical Exposure) Regulations (IRMER) 2000 and that a rectangular collimator is fitted to the X-ray machines.

• Review the current arrangements for the end to end decontamination process.
• Review the practice’s audit protocols to ensure audits of various aspects of the service accurately reflect the systems and processes and equipment defects.
• Review the current arrangements for tracking referrals.
• 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.

Before patients received any treatment they were told the treatment options, risks and costs. We saw signed consent records in all of the patient files we reviewed.

Patient care and treatment was delivered in a way that met their needs. We spoke with six patients and they told us that they were able to make an appointment with the dentist at a time that suited them. On the day of inspection we saw three patients who had attended for an urgent appointment. All three patients told us that they had called for an urgent appointment that morning and had been seen on the same day.

Patients were treated in an environment, which was clean and hygienic. We spoke with patients who also told us that the dentist was always clean and tidy.

Patients were protected from the risk of abuse because the provider had ensured staff had received training in the safeguarding of children and adults. There were appropriate safeguarding policies and procedures in place. Patients we spoke with also explained how safe they felt with the staff.

Each member of staff told us about the training and support they had received. This meant that patients were cared for by well trained and supported staff.

The practice asked patients for their feedback and concerns and improvements were acted upon. There were appropriate maintenance records to ensure the health, safety and welfare of patients.