We carried out an announced comprehensive inspection of this practice on 10 January 2017. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) Regulation 17: Good governance. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for @155 Dental Practice on our website at www.cqc.org.uk.

We carried out an announced follow up inspection on 3 August 2017 to ask the practice the following key question; Are services well-led?

Our findings were:

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

The dental practice @155 is located in premises situated to the west of Derby city centre. There are two treatment rooms, both of which are located on the ground floor. The practice provides solely private dental treatment. The practice has its own car park for patients to the rear of the premises.

The practice provides regulated dental services to both adults and children. Services provided include general dentistry, dental hygiene, crowns and bridges, oral surgery, implant placement, restoration and root canal treatments.

The practice’s opening hours are – Monday: 8 am to 6 pm; Tuesday: 8 am to 2 pm; Wednesday: 8:30 am to 4:30 pm; Thursday: 8 am to 3 pm; Friday: 8 am to 1 pm

Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. Like registered providers, they are ‘registered persons’. Registered persons 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 practice has one dentist; one oral surgery specialist, one therapist/ hygienist; two qualified dental nurses; and one receptionist.

Our key findings were:

• The practice had purchased an automated external defibrillator (AED) and all staff had taken part in medical emergencies training.
• The practice had purchased rubber dam kits and was following guidance from the British Endodontic Society in relation to endodontic treatment (root canal treatment).
• A new first aid kit had been purchased.
• Six monthly infection control audits had been completed in line with the Health Technical Memorandum 01-05: Decontamination in primary care dental practices (HTM01-05) published by the Department of Health.
• There was a full range of personal protective equipment (PPE) available within the practice to protect members of staff working in the decontamination room.
• A long handled brush and illuminated magnifying glass as identified in HTM 01-05 were available in the decontamination room.
• The practice had changed its protocol for dealing with matrix bands which made the process safer and ensured matrix bands were not reused.

We carried out an announced comprehensive inspection on 10 January 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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 not providing well-led care in accordance with the relevant regulations.

Background

The dental practice @155 is located in ground floor premises situated to the west of Derby city centre. There are two treatment rooms, both of which are located on the ground floor. The practice provides solely private dental treatment. The practice has its own car park for patients to the rear of the premises.

The practice provides regulated dental services to both children and adults. Services provided include general dentistry, dental hygiene, crowns and bridges, and root canal treatments. Services also include specialist oral surgery procedures including placement of implants

The practice’s opening hours are – Monday: 8 am to 6 pm; Tuesday: 8 am to 1pm; Wednesday: 8:30 am to 4 pm; Thursday: 8 am to 5 pm; Friday: 8 am to 1 pm

Access for urgent treatment outside of opening hours is by telephoning the practice and following the instructions on the answerphone message.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual registered person. Registered persons 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 practice has one dentist; one oral surgery specialist, one therapist/ hygienist; two qualified dental nurses; and one receptionist.

Before the inspection we sent CQC comments cards to the practice for patients to complete to tell us about their experience of the practice and during the inspection we spoke with patients. We received responses from six patients through comment cards and by speaking with them during the inspection. Those patients provided positive feedback about the services the practice provides.

Our key findings were:

• The premises were visibly clean and there were systems and processes in place to maintain the cleanliness.
• There were systems to record accidents, significant events and complaints. Learning points from these were recorded and used to make improvements.
• Records showed there were sufficient numbers of suitably qualified staff to meet the needs of patients.
• The practice did not have an automated external defibrillator (AED). A risk assessment regarding the AED sent to CQC after the inspection did not identify alternative arrangements to access an AED from another provider in an emergency situation.
• There were effective systems at the practice related to the Control of Substance Hazardous to Health (COSHH) Regulations 2002.
• Patients said they had no problem getting an appointment that suited their needs.
• Patients were able to access emergency treatment when they were in pain.
• Patients provided positive feedback about their experiences at the practice. Patients said they were treated with dignity and respect.
• Patients’ confidentiality was protected within the practice.
• The practice did not always follow the relevant guidance from the Department of Health's: ‘Health Technical Memorandum 01-05 (HTM 01-05) for infection control with regard to cleaning and sterilizing dental instruments.
• There was a whistleblowing policy accessible to all staff, who were aware of procedures to follow if they had any concerns about a colleague’s practice.
• The practice did not have the necessary equipment for staff to deal with medical emergencies, or a risk assessment identifying any alternative arrangements.

We identified regulations that were not being met and the provider must:

Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

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

• Review the practice’s protocols for the use of rubber dam for root canal treatment. The provider should consider the guidance issued by the British Endodontic Society when carrying out root canal treatments.

• Review availability of equipment such as an AED to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team. The provider must ensure a suitable risk assessment is undertaken if a decision is made to not have an AED on-site.