We carried out this announced inspection on 12 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.

We told the NHS England area team and Healthwatch 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

St Helen’s Dental Practice is in Cockermouth Cumbria and provides NHS services to children and private treatment to adults.

There is access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes five dentists, nine dental nurses (of which two are apprentices), four dental hygienists and three receptionists. The team is supported by a practice manager. The practice has five treatment rooms of which two are situated on the ground floor. The remaining three are situated on the first floor of the practice.

The practice is owned by an organisation 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 St Helen’s Dental Practice was the principal dentist.

On the day of inspection we collected nine CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, a dental nurse, a 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 8.30am – 7.00pm

Tuesday to Thursday 8.30am – 6.00pm

Friday 8.30am – 5.30pm

Our key findings were:

• The practice had a culture of preventative practice.
• The practice was clean and well maintained.
• The practice 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.
• The practice had suitable safeguarding processes and staff were aware of their responsibilities for safeguarding adults and children.
• The practice had staff recruitment procedures but these did not fully comply with regulation.
• 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.

We identified an area of notable practice.

• Members of the dental team displayed a positive culture towards improving the patient experience, especially that of children.
• The preventative care of children’s teeth was paramount in the practice.
• There was a dedicated room where children could be shown how to brush their teeth correctly and information was at a level to suit children. This room had two washbasins at different heights to enable children to practice cleaning their teeth.
• There were dedicated children’s dental nurses who worked with local schools and nurseries to promote children’s dental health. They provided children specific information leaflets and distributed free toothbrushes and toothpaste.
• The principal dentist was involved with the education of older people of the local population for example: giving talks about dental care to the local women’s institute.

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

• Review the service checks for the gas boiler and the fixed electrical wiring in the building to ensure they were safe and fit for purpose.

The people who were in the waiting room confirmed that the dentists and the dental nurses always explained what they were going to do. As part of the dental plan for children the practice had introduced a system to offer support in the community for oral health education and dietry advice. We saw staff speaking with people in a respectful manner and staff we spoke with understood the requirements for privacy, dignity and confidentiality. All of the people we spoke with told us that staff always asked for consent before they undertook any treatment or procedure. When we spoke with one person attending the practice for treatment they told us; “It is a warm and friendly practice. The staff are great and very supportive.”

The practice facilities were clean and well maintained with appropriate floor and surface coverings. We saw that protective equipment, including eye shields, face masks and gloves were available for staff to use when treating people. We found that staff received appropriate professional development and were able to obtain further qualifications. One member of staff told us; “We are a good team and have worked together for a long while”. We found that the practice did have a system in place which enabled them to regularly assess and monitor the quality of service that people received.