We carried out this short notice announced inspection on 18 October 2017 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.

We told the NHS England area team that we were inspecting the practice. We did receive information from them which was used to support this inspection. Prior to the inspection we had received some information of concern which was without substance. We reviewed comments about the practices on the NHS Choices web page. We reviewed these causes of concern throughout the inspection and our findings can be found in the main body of the report.

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

Mint Dental is in Windermere Cumbria and provides NHS and private treatment to both adults and children. There are Mint Dental practices in Ambleside and Barrow.

There is level access for people who use wheelchairs and pushchairs. On road car parking is available near the practice but this is time restricted.

The dental team includes one dentist and one trainee dental nurse. Qualified dental nurses from the sister practices support the dental team. The team is supported by a practice manager who is based in Barrow in Furness. The practice has three treatment rooms. The principal dentist is currently trying to recruit and retain staff for all three practices.

The practice is owned by an individual who is the principal dentist for the three Mint practices. 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.

During the inspection we spoke with the principal dentist and the trainee dental nurse. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Friday 8.30am – 5.00pm. The practice closes for lunch between 1.00pm and 2.00pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures which reflected published guidance. We found these were not always adhered to.
• Staff knew how to deal with medical emergencies. Appropriate medicines and life-saving equipment were available but these were not stored correctly.
• The practice had limited systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures. We were told there were experiencing difficulties in recruiting and retaining staff.
• 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 appointment system met patients’ needs.
• The practice had effective leadership. 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.

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

• Review the practice's protocols for medicines management and ensure all medicines are dated with their use by date and stored safely and securely.
• Review the current infection control protocols and the Legionella risk assessment and implement the required actions taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and have regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.’
• Review the protocols for the reporting of and the responding to accidents and incidents which occur within the practice. Staff should be aware of the reporting mechanisms.
• Review the practice's current audit protocols to ensure audits of key aspects of service delivery are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.

People we spoke with confirmed that the dentist and the dental nurses always explained what they were going to do. We saw staff speaking to people in a respectful manner and staff we spoke with understood the requirements for privacy, dignity and confidentiality. People told us that they were happy with the level of information they had received. We found that people were able to express their views and were involved in making decisions about their care and treatment. There was also strong agreement that staff were “very friendly”. One person told us; “Staff are all very good, they make it as pleasant as going to the dentist can be.” Whilst another person told us; “They always tell me what I need to know and explain everything before they do anything.”

The practice had appropriate equipment to support people in the event of an emergency. The practice facilities were clean and well maintained with appropriate floor and surface coverings. We found that staff received appropriate professional development and were able to obtain further qualifications. Staff confirmed they had on-going formal appraisal. We found that the practice had an effective system in place to monitor the quality of care provided