We carried out this announced inspection on 24 July 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 providing well-led care in accordance with the relevant regulations.

Background

Flaxpits Lane Dental Practice is in Winterbourne, Bristol and provides NHS and private general dental treatment to adults and children. In addition to this the practice holds an NHS contract to provide orthodontic treatment to children. Orthodontics is a specialist dental service concerned with the alignment of the teeth and jaws to improve the appearance of the face, the teeth and their function. Orthodontic treatment is provided under NHS referral for children except when the problem falls below the accepted eligibility criteria for NHS treatment. Private treatment is available for these patients as well as adults who require orthodontic treatment.

The practice is situated above a commercial business and is accessed through a side entrance and up a flight of stairs. The practice informs all new patients wishing to register that unfortunately they are not wheelchair accessible and signpost patients that cannot manage the stairs to a nearby practice. There is a free shopper’s car park opposite the practice which also has spaces available for blue badge holders.

The dental team includes three dentists, a visiting orthodontist, four dental nurses, two receptionists and a practice manager. The practice has two treatment rooms.

The practice is owned by a partnership 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 Flaxpits Lane Dental Practice is the principal dentist.

On the day of inspection we collected 18 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse, 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 from 9am to 6pm

Tuesday from 9am to 6pm

Wednesday from 9am to 5pm

Thursday from 9am to 5pm

Friday from 9am to 4pm

Our key findings were:

• The practice appeared clean and well maintained. The practice used a contracted company to provide cleaning services.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. One medicine was stored in the fridge in line with manufacturers guidance. We found that the fridge temperatures were not checked and recorded to ensure they remained at the correct temperature. A log was immediately created and a thermometer was ordered the following day.
• The practice had systems to help them manage risk to patients and staff.
• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances. The principal dentist had completed level three safeguarding training.
• The provider had thorough staff recruitment procedures, with the exception of retaining staff identification documents (ID) on personnel files. This had been identified and discussed at a recent staff meeting and staff had been requested to bring in copies of their ID to rectify this.
• 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. Patients could access treatment and emergency care when required.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided. Patient satisfaction survey results were consistently positive. These were displayed in the waiting room and on the practice website for patients to read.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

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

• Review the practice's policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken for all relevant dental materials and substances.

People who used the service understood the care and treatment choices available to them. We spoke with three people when we visited the practice. One person told us "I am always aware of the treatments I need and reasons why” and “I trust my dentist they always explain the options of my treatment with me”.

The dentists and dental nurses who worked at the surgery had Criminal Records Bureau (CRB) disclosures in place (now called DBS – Disclosure and Barring Service). These checks were undertaken to ensure they were suitable to work with vulnerable people and children.

General Dental Council registration was up to date for each of the dentists and the qualified dental nurses. They each had to submit evidence of continued professional development (CPD) each three years in order to retain their registration.

There were effective systems in place to reduce the risk and spread of infection. People that we spoke with said that the surgery was always clean and that they had no concerns about cleanliness or risk of infection. The dental nurses we spoke with knew that they had to transport used instruments via a specific route in the treatment room so as not to cross into a 'clean zone'. The dental nurses had supplies of personal protective equipment (gloves, aprons, goggles and a face mask).