We carried out this announced inspection on 12 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

Linden Dental Centre known locally as BUPA Dental Care is in Old Basing and provides private treatment to adults and NHS treatment to 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 six dentists, one specialist orthodontist, one lead dental nurse, seven dental nurses, one trainee dental nurse, four dental hygienists, one receptionist and one practice manager. The practice has five 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 Linden Dental Centre known locally as BUPA Dental Care is the practice manager.

On the day of inspection we collected 49 CQC comment cards filled in by patients and spoke with three other patients.

During the inspection we spoke with three dentists, one lead dental nurse, three dental nurses, one trainee dental nurse, one dental hygienist, one receptionist, one practice manager and the area manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday and Tuesday 8.30am to 6pm

Wednesday and Friday 8.30am to 5pm

Thursday 7am to 7pm

Saturday 8am to 12pm on alternate weeks

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.
• 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 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 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 and the storage of products identified under Control of Substances Hazardous to Health (COSHH) 2002 Regulations to ensure a risk assessment is undertaken and the products are stored securely.

• Review the practice’s infection control procedures and protocols 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’ in particular the practice review the flooring in treatment rooms to ensure it is of suitable clinical grade and installation in line with guidelines, included in this is the removal of inappropriate material blinds.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice, in particular the recording of patient consent.

We carried out an announced comprehensive inspection on 12 January 2017 to ask the practice the following key questions;

Are services safe, effective, caring, responsive and well-led?

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

Linden Dental Centre is a dental practice providing NHS and private treatment for both adults and children. The practice is based in a former domestic dwelling in Old Basing, a town situated in mid-Hampshire.

The practice has five ground floor dental treatment rooms and a separate decontamination room used for cleaning, sterilising and packing dental instruments.

The practice is accessible to wheelchair users, prams and patients with limited mobility.

The practice employs eight dentists who include an orthodontist, a periodontist and a visiting implant specialist, two hygienists, one therapist, six dental nurses, three multi trained reception/admin and nursing staff and a practice manager.

The practice’s opening hours are between 8.30am and 6.15pm on Monday, 8.30am and 6pm on Tuesday, 8.30am and 5pm on Wednesday and Friday and 8.30am and 7pm on Thursday.

There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

We obtained the views of 15 patients on the day of our inspection.

Our key findings were:

• We found that the practice ethos was to provide patient centred dental care in a relaxed and friendly environment.
• Effective leadership was provided by the practice owner and an empowered practice management team.
• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment were readily available in accordance with current guidelines.
• The practice appeared clean and well maintained.
• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.
• Infection control procedures were effective and the practice followed published guidance.
• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• There was a process in place for the reporting and shared learning when untoward incidents occurred in the practice.
• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• The service was aware of the needs of the local population and took these into account in how the practice was run.
• Patients could access treatment and urgent and emergency care when required.
• Staff received training appropriate to their roles and were supported in their continued professional development (CPD) by the practice owner.
• Staff we spoke with felt well supported by the practice owner and practice manager and were committed to providing a quality service to their patients.
• Information from 27 completed Care Quality Commission (CQC) comment cards gave us a positive picture of a friendly, caring, professional and high quality service.

There were areas where the provider could make improvements and should:

• Provide an annual statement in relation to infection prevention control required under The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Review the availability of hearing loops for patients who are hard of hearing.
• Review the safety arrangements of the window blinds in the practice, this could include ensuring the pull cords are made secure or carrying out a suitable risk assessment in relation to the pull cords.
• Review the systems to meet health and safety regulations with respect to fire; including the condition of the fire exit in the staff kitchen.
• Review patient information on the NHS Choices website.
• Consider providing details of the dentists General Dental Council (GDC) registration number in accordance with GDC guidance issued in March 2012 on the external name plate of the practice.
• Review practice systems to ensure that the training records of visiting clinicians are held by the practice.
• Review the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure that gaps in the employment history and reason for leaving previous employment of newly recruited staff are recorded.
• Consider the security of the doors into the decontamination room.

We spoke with patients during our visit, and also telephoned patients who had recently attended the clinic, for their views about their care.

Patients told us they were very pleased with the service. They said they had been given good information about their treatment choices, with options explained and discussed. As a result, they understood the risks and benefits of different options. We were told that reception staff were also courteous and helpful.

Everyone was complimentary about the quality of care provided. Those that were having treatments had received treatment plans and were aware of the costs. Patients said they had been asked to complete forms detailing their medical history.

Everyone we spoke with said the environment appeared clean and that clinical staff wore appropriate personal protective equipment, such as gloves and masks.