We carried out this announced inspection on 21 February 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 not 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 not providing well-led care in accordance with the relevant regulations.

Background

Alan Freedmans Dental Practice is in Salford and provides private treatment to adults and children.

A portable ramp is available for people who use wheelchairs and pushchairs. On street parking is available directly outside the practice.

The dental team includes two dentists, five dental nurses who also carry out reception and administrative duties (one of whom manages the practice and one is a trainee), and a dental hygiene therapist. The practice has two 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.

On the day of inspection we collected 10 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

During the inspection we spoke with the principal dentist, two dental nurses 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, Tuesday and Thursday 9am to 5.30pm

Wednesday 9am to 5.00pm

Friday 9am to 1.00pm

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures. Minor improvements were needed to the decontamination processes.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Not all staff had completed safeguarding training.
• Information relating to recruitment procedures was not readily available.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• Staff were open to discussion 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.
• Improvements could be made to the overall governance arrangements including the approach towards audit.

We identified regulations that were not being met and the provider must:

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

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

• Review the practice’s protocols and procedures for promoting the maintenance of good oral health giving due regard to guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’.

• Review its responsibilities to the needs of people with a disability and the requirements of the equality Act 2010 and ensure a Disability Discrimination Act audit is undertaken for the premises.

• Review the practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.

• The provider had not registered with the Health and Safety Executive (HSE) and the provider was not familiar with the new requirement for practices to register with the HSE.

We spoke with six patients attending for an appointment. The patients we spoke with told us that they were treated with respect and dignity. One patient when asked said “Absolutely I am always treated with respect and dignity from the minute I walk in the door until I leave.”

Patients spoken with confirmed that medical histories were taken. Patients told us that treatment options were discussed with them, this included the price of treatments.

Patients said they always felt they could raise anything of concern if necessary. We were told that they were more than happy with the care and treatment provided. Some comments from patients included: “The dentist is spot on, I am very happy with the advice and treatment,” “The staff are excellent, they are always friendly and helpful” and “The dentist is great, I have been coming for many years, he always asks if I have understood the information. The hygienist is excellent too. In fact the service overall is excellent.“

Patients told us that they were given protective equipment for example glasses and aprons to protect their clothes when having treatments and that the dentist wore gloves and face masks when treating them.

Patients told us that the surgery always looked clean and tidy.

All the patients spoken with told us they felt safe and trusted the advice of the dentist.

There was a suggestion box for people to provide their views held at the reception desk. There were no comments recently received.