We carried out this announced inspection on 19 April 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 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

Tenbury Dental Centre is in Tenbury Wells and provides predominantly private treatment with a small NHS provision to adults and children.

There is access via a portable ramp for people who use wheelchairs and those with pushchairs. Car parking spaces are available in a free car park near to the practice. Two car parking spaces for blue badge holders are available on the opposite side of the road to the practice.

The dental team includes one dentist, two qualified dental nurses, two trainee dental nurses, one dental hygienist and one practice manager. 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 five CQC comment cards filled in by patients and spoke with one other patient.

During the inspection we spoke with the principal dentist, one qualified dental nurse, two trainee dental nurses, one dental hygienist 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 to 5.30pm

Tuesday: 8.30am to 5.30pm

Wednesday: 8.30am to 5.30pm

Thursday: 8.30am to 5.30pm

Friday: 8.30am to 1pm, by appointment only.

Our key findings were:

• The practice appeared 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 mostly available, with the exception of out of date airways and defibrillator paediatric pads. There was no child mask and reservoir bag. The missing and out of date equipment was immediately ordered following our inspection and the process for checking equipment items was amended.
• The practice had systems to help them manage risk.
• The practice had a safeguarding lead with effective processes in place for safeguarding adults and children living in vulnerable circumstances.
• 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 practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement. Staff we spoke with felt well supported by the principal dentist and practice manager and were committed to providing a quality service to their patients.
• 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 staff dealt with complaints positively and efficiently.
• The practice had suitable information governance arrangements.

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

• Review the practice's recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.
• 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 for all relevant dental materials and substances.
• Review the availability of equipment in the practice to manage medical emergencies taking into account the guidelines issued by the Resuscitation Council (UK) and the General Dental Council.

During the inspection we spoke with the dentist, a dental hygienist, two dental nurses and the practice manager. After the inspection we spoke by telephone with five people who had used the practice to ask them about their experiences of the service.

People we spoke with were complimentary about the service they had received. One person told us that they would: “Recommend the dentist as have in the past been terrified of dentists but I’m extremely happy now”. Other comments included: “Immaculate” and: “Looks spotless”.

Systems were in place to ensure that the practice was clean and that instruments were sterilised. This was to make sure that people were not placed at risk of cross infection.

Arrangements were in place to make sure that people were protected from the risk of harm.

Staff received a range of training so that they were able to update their skills and knowledge.

There were systems in place that made sure people who used the practice were asked for their views about the service they received. This was so that the provider could use this information to make any necessary improvements. Audit systems were in place which made sure that people were not placed at risk of receiving inappropriate care and treatment.