We carried out this announced inspection on 8 April 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 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

Smileright Dencare Limited is in Basingstoke and provides private treatment to adults and children.

There is level access, through the shopping mall and lift access, through the adjacent shop, for people who use wheelchairs and those with pushchairs. Car parking spaces, including for blue badge holders, are available near the practice.

The dental team includes five dentists, one lead dental nurse, three dental nurses, three trainee dental nurses, one dental hygienist, one dental hygiene therapist, one practice manager and one receptionist. The practice has three 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 at Smileright Dencare Limited is the practice manager.

On the day of inspection, we collected 13 CQC comment cards filled in by patients and spoke with three other patients.

During the inspection we spoke with two dentists, one dental lead nurse, three trainee dental nurses, one registered manager from another practice, one compliance manager 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 Saturday 8.45am to 5.45pm

Our key findings were:

• The practice appeared clean and well maintained although improvements could be made to the cleaning file with additional documentation.
• 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.
• Improvements could be made to fire safety doors by the introduction of approved holding devices.
• The provider 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.
• Staff were providing preventive care and supporting patients to ensure better oral health.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement, however improvements could be made to make the clinical governance lead role more effective and dentists better informed about the role.
• improvements could be made to the auditing processes, including antimicrobial stewardship prescribing audits.
• Improvements could be made to Control of Substances Hazardous to Health (COSHH) Regulations 2002 file to ensure the safe storage and use of materials used.
• Improvements could be made by the introduction of a central referral monitoring system to ensure no cancer referrals were lost.
• 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.

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

• Review the practice's 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 protocols to ensure audits of radiography, dental care records, infection prevention and control, and antibiotic stewardship are undertaken at regular intervals to improve the quality of the service. The practice should also ensure that, where appropriate, audits have documented learning points and the resulting improvements can be demonstrated.

• Review the practice’s arrangements for ensuring good governance and leadership are sustained in the longer term, in particular the lead role of clinical director.

• Review the fire safety risk assessment and ensure and ongoing fire safety management is effective, in particular that fire safety doors are not wedged open to aid access when alternative methods exist.

People using the service said they were given appropriate information regarding their treatment, so they understood the choices available to them. They praised the dentists for the professional and caring way in which they explained their dental needs and the different treatment available.

Patients' needs were assessed and treatment was given in line with their individual treatment plan. We were told by one person using the service, “They’re excellent. They have really looked after me and explained everything. I’m so pleased I came in".

One person we spoke with said, “The dentist was excellent and the nurse was very considerate. They looked after me really well, especially after the treatment had finished.”

We found that people using the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

We saw that people were cared for in a clean, hygienic environment by staff who were supported to deliver care and treatment safely and to an appropriate standard. The practice had received no complaints since it opened.

In this report the name of Emma Lock appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.