We carried out this announced inspection on 11 December 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 not 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

Wiese and Associates Dental Practice is a well-established practice based in Cottenham that provides mostly private dental treatment to about 2,200 patients. The dental team includes three part-time dentists, two dental nurses and two reception staff. There is a practice manager based at the provider’s other service who assists in the running of the practice. There is one treatment room.

The practice opens on Mondays to Fridays from 9 am to 5.30 pm, and on Saturday mornings by arrangement.

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 23 CQC comment cards completed by patients. We spoke with one of the owners, a dentist, the practice manager, a nurse and a receptionist.

We looked at practice policies and procedures and other records about how the service is managed.

Our key findings were:

• Information from completed Care Quality Commission comment cards gave us a positive picture of a caring and professional service.
• The appointment system met patients’ needs and a text and email appointment reminder service was available.
• The practice appeared clean and well maintained, although some infection control procedures did not meet nationally recommended guidance.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff felt supported, appreciated and worked well as a team.
• The practice proactively sought feedback from staff and patients, which it acted upon.
• Medicines were not managed according to national guidance.
• Fire safety systems in the practice were not robust.
• Emergency equipment was not managed according to guidance and staff did not rehearse responding to incidents
• X-ray equipment had not been serviced according to guidance
• Legionella risk had not been properly assessed within the practice.

We identified regulations the provider was not meeting. They must:

• Ensure care and treatment is provided in a safe way to patients.

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

• Review the practice’s testing protocols for equipment used for cleaning used dental instruments taking into account guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and having regard to The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.

• Review the practice’s responsibilities to meet the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

• Review the management of dental care records to ensure they are stored securely.

People told us they had been treated with respect and been made welcome at the surgery whenever they had attended for treatment. They informed us that they had been provided with enough information about the charges and the types of treatment that had been available to them and that they were always encouraged to express their opinions about the course of treatment they preferred.

One person said, "The dentist is good with our children and speaks to them kindly and as an equal. They put them at ease so much that they like coming to the dentist." Another person said, "They are very considerate, that is why I keep coming here".