We carried out this announced inspection on 29 August 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

The Oral Health Practice is in the suburb of Wavertree, Liverpool and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. There is no designated car parking outside the surgery. We were told that any patients, displaying an appropriate blue badge permit in their car, can park on the extensive paved area immediately outside the practice.

The dental team includes six dentists, 11 dental nurses, one of whom is a trainee, one dental hygienist and three dental hygiene therapists. There is a practice manager, two assistant practice managers and a senior receptionist, all of whom are qualified dental nurses. The practice has six 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 46 CQC comment cards filled in by patients.

During the inspection we spoke with two dentists, one dental nurse, one dental hygiene therapist, the assistant practice manager and the newly recruited practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open Monday to Thursday, between 8am and 6pm, and on Friday from 8am to 5pm. The practice does offer some Saturday morning clinics to meet demand.

Our key findings were:

• The practice was clean and well maintained.
• 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.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had staff recruitment procedures in place, but no formal recruitment policy.
• The majority of required recruitment checks were in place for 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 provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and a strong culture of continuous improvement.
• 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 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 staff recruitment procedures including verification that staff have been confirmed as having sufficient immunity to blood-borne viruses.
• Review levels of indemnity for any locum staff at the practice, and that this is sufficient and takes account of any other work completed by those staff.
• Introduce a monitoring system to confirm that all staff are appraised at least annually.

We spoke with four people who used the service. People told us that they had no concerns or issues with the practice. They told us "Perfect, looked after things for me and educated me”, “Glad of the opportunity to say how good the practice is”, “efficient and well run, probably the best dentist."

Everyone we spoke with said they would feel confident to raise an issue if needed and they would know how to raise a concern.

The dental surgeries we looked at on the day of the visit were of a suitable size and were clean and well maintained. Each room was fully equipped and we observed staff carrying out cleaning procedures in between each patient, thus minimising the risk of cross infection.

The practice had comprehensive systems in place to maintain, monitor and improve the care and safety of people using the service.