We carried out an announced comprehensive inspection on 2 March 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

259 Manningham Lane is situated in Bradford, West Yorkshire. The practice provides NHS dental treatments to adults and children. The services include preventative advice and treatment and routine restorative dental care.

The practice has one surgery, a decontamination room, a waiting area and a reception area. All of the facilities are on the ground floor of the premises along with toilet facilities. Due to the nature of the premises access for wheelchair users of those with limited mobility is restricted.

There are three dentists, one dental nurse and two receptionists.

The opening hours are Monday to Thursday from 9:00am to 6:00pm and Friday from 9am to 12:30pm.

During the inspection we received feedback from 51 patients. The patients were generally positive about the care and treatment they received at the practice. Comments included staff were polite, friendly and welcoming. Some patients were unhappy with the availability of appointments, frequently cancelled appointments and the dentists changing.

Our key findings were:

• The practice was visibly clean and uncluttered.
• The practice did not have effective systems in place to assess and manage risks to patients and staff.
• Staff were qualified and had received training appropriate to their roles.
• A robust recruitment process was not followed.
• There was not a robust process in place to correspondence returned from hospitals was opened and stored appropriately.
• Patients were involved in making decisions about their treatment and were given clear explanations about their proposed treatment including costs, benefits and risks.
• Dental care records showed treatment was planned in line with current best practice guidelines.
• Oral health advice and treatment were provided in-line with the ‘Delivering Better Oral Health’ toolkit (DBOH).
• We observed patients were treated with kindness and respect by staff.
• Staff ensured there was sufficient time to explain fully the care and treatment they were providing in a way patients understood.
• The practice complaints policy was not displayed and verbal complaints were not documented.
• The majority of patients were able to make routine and emergency appointments when needed.
• The governance systems were not effective. Polices had been recently implemented and staff were unfamiliar with these and how to access them.
• There were clearly defined leadership roles within the practice and staff told us they felt supported, appreciated and comfortable to raise concerns or make suggestions.
• Audit was not well embedded within the practice.

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

• Ensure the practice undertakes a Legionella risk assessment and implements the required actions giving due regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
• Ensure the practice knows about their responsibilities in regards to Control of Substance Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Ensure a fire risk assessment and actions are implemented to ensure and effective risk management system is in place.
• Ensure infection control audits are undertaken at regular intervals and learning points are documented and shared with all relevant staff.
• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure a system for monitoring correspondence relating to referrals is implemented.

We identified breaches of regulations 17 (Good governance) and 19 (Fit and proper persons employed) during this inspection. CQC is unable to take enforcement action against the provider regarding these breaches as they are registered with us as partnership but should be registered as a sole provider. Immediate steps are being taken by the provider to rectify the situation by submitting a registration application to us as a sole provider.

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

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the practice’s system for the recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and, ensuring that improvements are made as a result.
• Review availability of equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK).
• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Establish whether the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review the storage of dental care records to ensure they are stored securely.
• Review its complaint handling procedures and establish an accessible system for identifying, receiving, recording, handling and responding to complaints by patients.

We found the dentists fully explained any necessary care and treatment with people to ensure they were fully informed before they signed their consent. We also found people's care and welfare was central to the care provided and people's risks were assessed and managed appropriately.

We found the practice was visibly clean and the necessary decontamination standards were being met. In addition, we found the provider had a suitable complaints processes in place and staff clearly understood the arrangements for managing complaints. We also found staff were supported in their work and offered the necessary training and support.

We spoke with three people who attended the practice for a check-up/treatment. One person said they had been attending the practice for 30 years and it was "A friendly practice." They also said the dentists were responsive if they, or a member of their family, needed emergency care/treatment. The second person we spoke with had no complaints and they said "The dentists explain things well" and reception staff would help translate if necessary. The third person we spoke with said they didn't know the new dentist that well and they didn't have any problems about the practice.