We carried out this announced inspection on 20 December 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

Ingrams Dental Practice is located in Coalville, a market town in North-West Leicestershire. It provides private treatment to adults and has a contract to provide NHS care for children.

The practice provides general dentistry, sedation, implants and cosmetic procedures.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available in the practice’s car park at the front of the premises.

The dental team includes two dentists and five dental nurses. Three of the dental nurses share receptionist duties. Practice administrative/management duties are shared amongst the team.

The practice has two treatment rooms on ground floor level and a separate decontamination facility.

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 Ingrams Dental Practice is one of the dentists and joint owner of the practice.

On the day of inspection, we collected 25 CQC comment cards filled in by patients. We also received many comments from patients who left feedback online at CQC.

During the inspection we spoke with two dentists and five dental nurses. We looked at practice policies and procedures, patient feedback and other records about how the service is managed.

The practice is open: Monday, Tuesday and Thursday from 8.30am to 5.30pm, Wednesday from 8.30am to 7pm and Friday from 8.30am to 1pm.

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. Appropriate medicines and life-saving equipment were available on the day of inspection with the exception of midazolam which was not held in buccal form, a child oxygen face mask with reservoir and tubing was not present and some needles and syringes required replacement. Immediate action was taken after the inspection to obtain or replace the items.
• The practice had systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes although some improvements were required as some staff had not completed training to level 2 at the time of our inspection. This was completed the following day. Staff showed awareness of their responsibilities for safeguarding vulnerable adults and children.
• Staff knowledge of the Mental Capacity Act 2005 and Gillick competence required discussion to ensure that all had a comprehensive understanding.
• The provider had staff recruitment procedures in line with legal requirements.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• The practice provided sedation to those patients who would benefit. They told us they may not continue to offer the service in the future. We found that improvements could be made in relation to recording blood pressure monitoring and recording. The practice held one oxygen cylinder; the provider told us they would obtain a second cylinder.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The provider asked staff and patients for feedback about the services they provided.
• 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 protocols for conscious sedation, taking into account the guidelines published by The Intercollegiate Advisory Committee on Sedation in Dentistry in the document 'Standards for Conscious Sedation in the Provision of Dental Care 2015.
• Review staff awareness of the requirements of Gillick competence and the Mental Capacity Act 2005 and ensure all staff are aware of their responsibilities and how it relates to their role.

We spoke with two patients following their appointment with a dentist and asked them about their experience. Patients told us they were very pleased with the service. They told us about the treatment they had been recommended or had received. They said that the dentist had given them information about their treatment options and what these entailed, including information about fees.

Patients told us their appointments were on time and that they did not experience a delay in booking an appointment and that emergency appointments were readily available.

Patients told us they found the practice and treatment rooms to be clean and tidy and confirmed that dentists and dental nurses wore protective clothing when providing treatment.

Patients comments included: - “My treatment plan was discussed with me and I’ve previously been referred to other specialists.” “My options have been explained to me, and the dentist has given me information to take away and read, I know about the fees involved and the dental plan.” And “it’s just a nice and friendly practice.”