We carried out an unannounced follow-up inspection at Anthony J Cale & Associates on 6 March 2018.

We had undertaken an announced comprehensive inspection of this service on the 24 February 2017 as part of our regulatory functions where a breach of legal requirements was found. A follow up inspection was carried out on 29 September 2017 where we were not assured that improvements had been made.

After the follow up inspection we wrote to the registered manager asking them to submit an action plan saying what they would do to meet the legal requirements in relation to the breach. An action plan was not submitted.

We reviewed the practice against one of the five questions we ask about services: are the services well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Anthony J Cale & Associates on our website at www.cqc.org.uk.

We revisited Anthony J Cale & Associates as part of this review and checked whether they now met the legal requirements. We carried out this unannounced inspection on 6 March 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.

• Is it well-led?

This question forms the framework for the areas we look at during the inspection.

Our findings were:

Are services well-led?

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

Background

Anthony J Cale & Associates is in Barnsley and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes three dentists, seven dental nurses (one of whom is a trainee) and a practice manager. The dental nurses also cover reception duties. 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 Anthony J Cale & Associates was one of the dentists.

The practice is open:

Monday and Wednesday to Friday from 9am to 5:30pm

Tuesday from 9am to 7pm

Saturday from 9am to 12pm

Our key findings were:

• The practice had recently been taken over by a new owner and was currently undergoing refurbishment.
• Improvements had been made to the process for reducing the risks associated with fire.
• The recruitment process was effective and relevant checks were carried out.

We carried out a follow-up inspection at Anthony J Cale & Associates on 29 September 2017.

We had undertaken an announced comprehensive inspection of this service on the 24 February 2017 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection we wrote to the principal dentist asking them to submit an action plan saying what they would do to meet the legal requirements in relation to the breach. An action plan was not submitted.

We reviewed the practice against one of the five questions we ask about services: are the services well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Anthony J Cale & Associates on our website at www.cqc.org.uk.

We revisited Anthony J Cale & Associates as part of this review and checked whether they now met the legal requirements. We carried out this announced inspection on 29 September 2017 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.

• Is it well-led?

This question forms the framework for the areas we look at during the inspection.

Our findings were:

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

Anthony J Cale & Associates is in Barnsley and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes two dentists, seven dental nurses (one of whom is a trainee) and an office manager. The dental nurses also cover reception duties. A new dentist was due to start the Monday after the inspection. 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 Anthony J Cale & Associates was the principal dentist.

The practice is open:

Monday and Wednesday to Friday from 9am to 5:30pm

Tuesday from 9am to 7pm

Saturday from 9am to 12:pm

Our key findings were:

• Some improvements had been made to the processes for reducing the risks associated with fire. Further improvements could be made.
• The practice had carried out audits of infection prevention and control and X-rays. The infection prevention and control audit did not have an action plan.
• The COSHH folder had been updated.
• Records relating to service users and people employed were now stored securely.
• Issues relating to the recruitment of staff had not been fully addressed.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We carried out an announced comprehensive inspection on 24 February 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

Anthony J Cale & Associates is situated in Barnsley, South Yorkshire. The practice provides dental treatment to adults and children on an NHS or privately funded basis. The services include preventative advice and treatment and routine restorative dental care.

The practice has three surgeries, an X-ray developing room, two waiting areas, a reception area and staff facilities. There are two surgeries, the reception area, a waiting area, the X-ray developing room and toilet facilities on the ground floor. The other surgery, second waiting area and staff facilities are on the second floor.

There are three dentists (one of whom is a locum), seven dental nurses (one of whom is a trainee), and an office manager. The dental nurses also cover reception duties.

The opening hours are Monday and Wednesday to Friday from 9:00am to 5:30pm, Tuesday from 9:00am to 7:00pm and Saturday from 9:00am to 12:00pm.

The principal dentist is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. 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.

During the inspection we received feedback from three patients. The patients were positive about the care and treatment they received at the practice. Comments included staff were excellent and friendly. They also commented they had sufficient privacy during treatments.

Our key findings were:

• The surgeries were cluttered but appeared clean and hygienic.
• Systems in place to assess and manage risks to patients and staff including fire and Control of Substances Hazardous to Health (COSHH) were ineffective.
• Staff were qualified and had received training appropriate to their roles.
• The recruitment process was ineffective.
• 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 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.
• The practice had a complaints system in place and there was an openness and transparency in how these were dealt with.
• Patients were able to make routine and emergency appointments when needed.
• The governance systems were not effective.
• Clinical audit was not embedded within the practice.

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

• 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 the storage of records relating to service users and people employed by the registered provider are in accordance with current legislation and guidance.
• Ensure audits of various aspects of the service, such as radiography and infection prevention and control are undertaken at regular intervals to help improve the quality of service. The practice should also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.
• Ensure products identified under the Control of Substances Hazardous to Health (COSHH) 2002 Regulations are stored appropriately.

You can see full details of the regulations not being met at the end of this report.

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 process for the storage of documentation relating to the servicing and maintenance of equipment.
• Review the security of prescription pads in the practice.
• Review the practice’s infection control procedures and protocols 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.

We found patients were fully involved in decisions relating to their treatment and care. We found patients privacy and dignity was maintained whilst attending the practice.

We talked with four patients during the inspection who spoke highly about the care, support and treatment they received from the dentists and other staff. Some patient comments captured included, “[staff are] friendly, efficient and have good interpersonal skills”, “[my dentist] is really nice”, “never any problems, I’m happy coming here”, and “[my overall experience] very accommodating and very friendly”.

We found processes were in place to safeguard children and vulnerable adults from the risks of abuse.

We conducted a tour of the premises and found it was clean and tidy. There were systems in place to reduce the risk and spread of infection.

We found staff were adequately supported because they received regular training sessions and an annual appraisal.

We found there were effective systems to regularly assess and monitor the quality of service that patients received.