We carried out this announced inspection on 8 October 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

The dental practice, Killingworth Health Centre, is in Newcastle Upon Tyne 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 are available near the practice.

The dental team includes 11 dentists, 12 dental nurses (one of whom is a trainee), a decontamination assistant, two dental hygiene therapists, an orthodontic therapist, the practice manager and four receptionists. A compliance lead oversees the management of the dental practice. The practice has seven 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 Killingworth Health Centre is the practice manager.

On the day of inspection, we collected 25 CQC comment cards filled in by patients.

During the inspection we spoke with three dentists, seven dental nurses, the decontamination assistant, the practice manager and the compliance lead. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Thursday 8am to 6pm

Tuesday 8am to 8pm

Wednesday 8am to 7pm

Friday 8am to 5pm

Saturday 9am to 4pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice had infection control procedures which reflected published guidance. The security of clinical waste required reviewing.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risks to patients and staff. Some aspects of these were ineffective.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Training in safeguarding was not monitored adequately.
• The practice had staff recruitment procedures; these required reviewing.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• 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.
• The practice dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.
• The process for monitoring staff training in topics such as infection prevention and control and medical emergency training required strengthening.
• There were inconsistencies identified in X-ray maintenance and examination reports. These were not recognised by managerial staff.

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

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• Review the security of clinical waste storage, taking into account the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices, and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’.
• Review the practice’s protocols for ensuring that all clinical staff are up-to-date in their continuing professional development.
• Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.