We carried out this announced inspection on 9 January 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.

We told the NHS England Cheshire and Merseyside area team that we were inspecting the practice. We did not receive any information of concern from them.

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

Smithdown Dental Practice is situated in a suburb of Liverpool and provides dental care and treatment to adults and children on an NHS and privately funded basis.

The provider has a portable ramp available to facilitate access to the practice for wheelchair users. The practice has three treatment rooms. Car parking is available near the practice.

The dental team includes a principal dentist, three associate dentists and eight dental nurses, three of whom also carry out reception duties, and four of whom are trainees. The team is supported by a practice manager.

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.

We received feedback from 25 people about the services provided. The feedback provided was positive about the practice.

During the inspection we spoke to two dentists, five dental nurses and the practice manager. We looked at practice policies, procedures and other records about how the service is managed.

The practice is open:

Monday and Tuesday 9.00am to 6.00pm

Wednesday 9.00am to 5.30pm

Thursday 9.00am to 5.00pm

Friday 9.00am to 3.30pm.

Our key findings were:

• The practice was clean and well maintained.
• The practice had infection control procedures in place which reflected published guidance.
• Safeguarding processes were in place and staff knew their responsibilities for safeguarding adults and children.
• Staff provided patients’ care and treatment in line with current guidelines.
• The practice had a procedure in place for dealing with complaints.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system took patients’ needs into account. Dedicated emergency appointments were available.
• The practice had a leadership structure. Staff felt involved and supported and worked well as a team.
• The practice asked patients and staff for feedback about the services they provided.
• Staff knew how to deal with emergencies. We observed that two sizes of oro-pharyngeal airway and a child size self-inflating resuscitation bag were not available.
• The practice had systems in place to help them manage risk. Not all risks from sharp instruments had been assessed and reduced.
• The practice had staff recruitment procedures in place. We found that the practice did not request employment histories or references for all staff prior to employment.

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

• Review the availability of equipment to manage medical emergencies taking account of the guidelines issued by the Resuscitation Council (UK), and the General Dental Council.
• Review the practice's recruitment policy and procedures to ensure character references for new staff as well as employment histories are requested and recorded suitably.
• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities, specifically in relation to staff immunity status to Hepatitis B, and to sharps.
• Review the practice’s protocols in relation to the use of closed circuit television to ensure staff and patients are fully informed as to its purpose and their right to access footage containing their images.

We spoke with people who used the service. They told us they had been very satisfied with the treatment they had received. Each person we spoke with told us they were given options about their treatment when they visited the dentist. People told us the dentist explained different treatment options that were available and what the treatment entailed.

People told us the service had been professional, reliable and friendly and that they felt the dentists were skilled. They told us that as 'patients' they had always been made welcome and were reassured by all of the staff at the surgery. People told us they had signed documentation to give their consent to treatment and that staff checked peoples' medical histories and medication on a regular basis.

People told us they found the surgery to be clean and hygienic and that staff had high standards of cleanliness and infection control. When we looked around the practice we saw evidence that the premises were kept clean. We also saw evidence of effective infection control systems in place and good practice being followed.

When we looked at training records we saw evidence that the dentist, dental nurses and trainee dental nurses had been professionally trained to the level their positions required. We also saw that they had completed training in other appropriate courses.

We saw evidence that there was a quality assurance system in place that informed the future performance of the service.