We carried out this announced inspection on 6 March 2019 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

Kent House Health Centre known locally as Lyme Bay Medical and Dental Practice is in Lyme Regis and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces, including those for blue badge holders, are available near the practice.

The dental team includes two dentists, three dental nurses, one trainee dental nurse, one dental hygienist, one receptionist and one practice manager. The practice has four treatment rooms.

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. The registered manager at Kent House Health Centre known locally as Lyme Bay Medical and Dental Practice is the principal dentist.

On the day of inspection, we collected 28 CQC comment cards filled in by patients and spoke with five other patients.

During the inspection we spoke with two dentists, two dental nurses, one trainee dental nurse and the 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 and Tuesday 8am to 6.30pm

Wednesday, Thursday and Friday 8am to 5.30pm

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.
• The practice had systems to help them manage risk to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines, although patient care records and various audits could be improved.
• 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 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 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 the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• 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 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 and the products are stored securely.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.
• Review the practice’s protocols to ensure audits of radiography, dental care records, infection prevention and control, and antibiotic stewardship are undertaken at regular intervals to improve the quality of the service. Practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

We carried out this inspection to determine if the provider had taken action to rectify the areas of non-compliance related to the assessing and monitoring of the quality of service provision to patients, which we found during our inspection in December 2013.

During this inspection in May 2014, we found the provider had monitored and assessed the quality of the services they provided. This had been achieved through a patient survey carried out in February 2014. Plans were in place to undertake further patient surveys.

During the inspection we spoke with five people regarding their experience of the service and their involvement in treatment planning. We were told that treatment plans were provided which included information about the course of recommended treatment and the cost. The patients we spoke with told us that aftercare advice was given following a course of treatment. Comments included “I am given enough information to make decisions. I always ask lots of questions. They just get on with the job and do it fairly well”.

We viewed five treatment plans. We found that treatments were explained and that the costs were documented. People said that appointments could be made easily and emergency appointments were dealt with within acceptable time limits.

Patients who used the service were protected against the risks of unsafe or unsuitable premises as appropriate measures had been put in place to ensure they were safe.

We saw that the practice was organised and that staff had a reasonable understanding of infection control procedures. We found that there were arrangements in place to ensure that equipment was kept clean and ready for use.

We found that there were not robust procedures in place to assess and monitor the quality of service provision. People who used the practice were not encouraged to provide feedback about the care and treatment they received.