We carried out this announced inspection on 4 April 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

Worcester Road Dental Practice is in Droitwich and provides NHS and private treatment to adults and children.

There is a step into the practice which is accessed with the use of a portable ramp for people who use wheelchairs and those with pushchairs. Car parking spaces are available in the practice car park.

The dental team includes four dentists, five dental nurses (all cover reception duties and two are trainee dental nurses), a dental hygiene therapist and a practice manager. The practice has three 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 spoke with four patients.

During the inspection we spoke with two dentists, two dental nurses 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 to Thursday from 9am to 5.30pm.

Friday from 9am to 5.15pm.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which did not fully reflect published guidance. Improvements were made to strengthen processes within 48 hours of our inspection.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available with the exception of a child self-inflating bag with reservoir, child and adult oxygen face masks with reservoir and tubing and clear face masks for the self-inflating bag sizes 0,1,2, 4. The oxygen cylinder was not the correct size as detailed in the resuscitation guidelines and the defibrillator checks were not logged. These items were ordered on the day of our inspection and a log was implemented to check the defibrillator.
• The practice had systems to help them manage risk to patients and staff.
• The provider had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Safeguarding contact details and flow charts were displayed in the waiting room.
• The provider had staff recruitment procedures although right to work documentation and photographic identification of staff were not retained on all personnel files.
• 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. They routinely referred patients to their dental hygiene therapist through a clear care pathway.
• The appointment system took account of patients’ needs. Patients could access routine treatment and urgent care when required.
• 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 recruitment policy and procedures to ensure accurate, complete and detailed records are maintained for all staff.

As part of our inspection, we spoke with five people who were registered with the practice by telephone. We also spoke with the principle dentist (who is also the provider), one dental nurse and the receptionist (who is also a trained dental nurse) about working at the practice.

People were complimentary about the care and treatment they and their family members (where applicable) received. People told us they were given enough information about their treatment options. One person told us: “It is a good little practice” and they (staff) gave stickers to their children to make them feel relaxed. Another person said: "She (dentist) is just marvellous, makes me feel really comfortable”.

We saw that the practice was clean and well organised and that staff had a good understanding of infection control procedures. We saw that there were arrangements in place to ensure that equipment was kept clean and ready for use.

During our inspection we saw that all staff had appropriate essential employment checks in place. This showed that staff were suitable to work with vulnerable people. One person said that they felt the dentist: “Knew their subject” and this was: “Reassuring”.

There were arrangements for monitoring the quality of the service. People who used the practice were encouraged to provide feedback about the care and treatment they received. This meant that the principle dentist actively encouraged feedback and used it to influence the way care was provided.