We carried out this announced inspection on 12 February 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

Background

Linden Lodge Dental Care is in Clevedon and provides NHS and private treatment to adults and children.

There are steps into the practice with hand rails available for assistance. For people who use wheelchairs, and those with pushchairs, level access is provided by a portable ramp which can be erected for this purpose. Car parking spaces are available in the road near the practice.

The dental team includes three dentists and a visiting dentist with special interest in orthodontics, four dental nurses and one trainee dental nurse, one dental hygienist, a practice manager and one receptionist. The practice has four 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.

At the time of inspection there was no registered manager in post as required as a condition of registration. A registered manager is legally responsible for the delivery of services for which the practice is registered.

On the day of inspection, we collected 41 CQC comment cards filled in by patients and spoke with three other patients.

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

The practice is open:

• Monday - Thursday 09:00am – 1.00pm and 2.00pm - 5.30pm
• Friday 09.00am – 1.00pm and 2.00pm - 4.00pm
• Closed at weekends

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 limited systems to help them manage risk to patients and staff.
• The provider had some safeguarding processes and staff demonstrated limited knowledge of their responsibilities for safeguarding vulnerable adults and children.
• 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had limited leadership and evidence of continuous improvement was minimal.
• 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.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Send CQC a written report setting out what governance arrangements are in place and the plans to make improvements.

Full details of the regulation/s the provider was/is not meeting are at the end of this report.

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

• Review the fire safety risk assessment and ensure that any actions required are complete and ongoing fire safety management is effective.

• Review the practice safeguarding policy and ensure it takes into account both adults and children and contains the relevant information for reporting suspected abuse and includes the local contact numbers for children and vulnerable adults.

• Review staff training to ensure all the staff have understood training received in the safeguarding of children and vulnerable adults and can apply it in practice.

• Review the practice 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 relating to decontaminating in surgery.

• Review the practice Legionella risk assessment and implement any recommended actions, 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 recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice. In particular relating to Disclosure and Barring Checks (DBS) being completed prior to employment.

• Introduce protocols regarding the prescribing of antibiotic medicines taking into account the guidance provided by the Faculty of General Dental Practice. Introduce an annual antimicrobial prescribing audit.

• Review the practice arrangements for ensuring good governance and leadership are sustained in the longer term.

• Review the provider's registration conditions to ensure the regulated activities at Linden Lodge Dental Care are managed by an individual who is registered as a manager.

• Review the practice protocols to ensure audits of record keeping 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 an announced comprehensive inspection on 29 September 2015 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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found this practice was providing well-led care in accordance with the relevant regulations.

Background

Linden Lodge Dental Practice is a medium sized practice located in the centre of Clevedon. It provides NHS and private general and cosmetic dentistry to people living or working in the area. The practice has four general dentists and one dental hygienist. There are payment systems available, such as Denplan, for private patients to pay for treatments. The dental centre is open from Monday to Friday from 9am to 5pm but routinely closes for lunch between 1pm to2pm daily unless there are any patients requiring emergency treatment.

There is a registered manager in place, a registered manager is a person who is registered with the Care Quality Commission 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 reviewed 57 comment cards that had been completed by patients. The comments made praised the treatment provided and the staff team. Patients said they received professional, caring and compassionate care in a very friendly and clean environment. They used comments such as ‘first class service’ and ‘excellent’ to describe their experience of the practice.

Our key findings were:

• There were effective systems in place to reduce the risk and spread of infection.
• All treatment rooms were well organised and equipped, with good light and ventilation.
• There were systems in place to check all equipment had been serviced regularly, including the air compressor, autoclave, fire extinguishers, oxygen cylinder and the X-ray equipment.
• Dentists regularly assessed patients according to appropriate guidance and standards including assessment of gum health and taking X-rays at appropriate intervals.
• Staff maintained the necessary skills and competence to support the needs of patients.
• Staff were up to date with current guidelines and was led by a proactive management team.
• Staff were kind, caring, competent and put patients at their ease.

In addition there were two areas the provider could make improvements and should:

• Review its audit protocols to document learning points that are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.

• Review the practice's recruitment arrangements to ensure they are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.