We carried out this announced inspection on 12 March 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

The Paddox Dental Practice is in Hillmorton, Rugby and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Car parking spaces are available in the surrounding streets close to the practice.

The dental team includes three dentists, an orthodontist, an orthodontic therapist, three dental nurses, three dental hygienists, two receptionists and a practice manager. 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 The Paddox Dental Practice is the practice manager.

On the day of inspection, we collected 14 CQC comment cards filled in by patients.

During the inspection we spoke with one dentist, one orthodontist, three dental nurses (one of whom was a trainee), one 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 from 9am to 7.30pm.

Tuesday from 9am to 5pm.

Wednesday from 9am to 5pm.

Thursday from 8.30am to 5pm.

Friday from 9am to 3pm.

Our key findings were:

• The practice appeared clean and well maintained. Comments received from patients confirmed this was usual.
• 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 with the exception of child and adult self-inflating bags with reservoirs, child and adult oxygen face masks with reservoir and tubing and clear face masks for the self-inflating bag sizes 0,1,2, 3, 4. These items were ordered on the day of our inspection.
• The practice had systems to help them manage risk to patients and staff. The five yearly electrical fixed wire testing was last completed in 2012 and had lapsed. We were advised that it had been scheduled for completion on the 28 March 2019.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures. Personnel files contained evidence that all clinical staff had received the Hepatitis B vaccinations however the immunity levels were not detailed for all staff members to ensure that they were adequately immunised.
• 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 practice offered extended hours appointments opening until 7.30pm on Mondays and from 8.30am on Thursdays.
• The provider had effective leadership and culture of continuous improvement.
• 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 protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the practice's systems for checking and monitoring premises maintenance taking into account relevant guidance and ensure that all services are well maintained. In particular ensuring that five yearly electrical fixed wire testing is completed within relevant timeframes.
• Review the practice's protocols for completion of dental care records taking into account the guidance provided by the Faculty of General Dental Practice.

On the day of our visit we found that some of the public information about the practice needed updating. The provider explained they had agreed a long term handover plan with the previous provider, because the previous provider had worked at the practice as an associate until recently.

We spoke with four people who used the service. They told us they had attended the surgery for years and appreciated that changes had been made gradually. They told us they had all the information they needed. One person told us, “I am always made to feel welcome.”

People told us the dentist explained their treatment options and costs, but they made their own decision. In the three patient records we looked at, we saw that people signed their treatment plans. People told us, “He was very nice, made me feel welcome” and “He explained everything.”

The provider minimised risks to people’s health and wellbeing because they had effective infection prevention and control measures. The three dental nurses we spoke with told us the provider checked their suitability and competence for their role. The provider made sure that medicines and equipment to deal with emergencies were always available.

The provider’s quality assurance system included asking people their opinions and monitoring staff’s practice. The provider’s complaints policy was made available for people. People told us they knew their opinions were respected and they believed the provider would deal with complaints appropriately.