We carried out this announced inspection on 13 November 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 and an additional CQC inspector.

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 not 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

Wilton Dental Practice is in Wilton on the outskirts or Salisbury 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 two dentists (one of whom is the principal dentist), two trainee dental nurses, one receptionist and a practice manager. The practice has three treatment rooms, one of which we were assured by the provider was not currently used to treat patients.

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.

On the day of inspection, we collected 37 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with both dentists, two trainee dental nurses, one receptionist 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 to Thursday 08.45am – 1.00pm and 2.00pm – 5.00pm
• Friday 08.45am – 1.00pm

• Closed at weekends.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance, although there was scope to improve the application of the procedures.
• Staff knew how to deal with emergencies and had the appropriate medicines available. Not all the appropriate life-saving equipment was available.
• The practice had some systems to help them manage risk to patients and staff but they were not robust. For example, the the health and safety risk assessment of the practice and the sharps equipment.
• The provider had suitable safeguarding processes. and staff knew their responsibilities for safeguarding vulnerable adults and children. Staff had received training and mostly knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had suitable 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.
• 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 a culture of continuous improvement but more work was required to ensure good governance of the practice.
• 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 adequately.
• The provider had suitable information governance arrangements.

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

• Ensure care and treatment is provided in a safe way to patients. For example:

  • Ensure the practice sharps procedures are compliant with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
  • Ensure all staff are fully conversant with, and are able to apply, 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 practice.
  • Ensure the high risk recommended actions from the Legionella and fire risk assessments are addressed to minimise risk to patients.
  • Ensure the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care especially with regard to significant event reporting, recording and management with a view to preventing further occurrences and ensuring that improvements are made as a result.

• Ensure systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities are completed by competent persons to ensure all risk are identified and actions taken to mitigate the risks. E.g. health and safety risk assessment of the practice.

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

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

• Review the practice 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 responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010 taking account of people living with hearing and sight loss.