Further to the outcome of a previous inspection, carried out in March 2016, we carried out an announced focused inspection relating to the safe and well led provision of services on 11 May 2016 to ask the practice the following key questions;

Are services safe and well-led in relation to staff recruitment, infection control and staffing?

Our findings were:

Are services safe?

We found that this practice was providing safe 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

CQC inspected the practice on 17 March 2016 and asked the provider to make improvements regarding:

• Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment

• Regulation 18 HSCA (RA) Regulations 2014 Staffing

• Regulation 19 HSCA (RA) Regulations 2014 Fit and Proper Persons employed

We checked these areas as part of this focused inspection and found these had been resolved.

Avenue House Dental Practice is a dental practice providing private treatment for both adults and children.

The practice is situated in Lymington town centre. The practice has five dental treatment rooms, of which four are in use, and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The practice is based on the ground and first floor of a former detached domestic dwelling. The ground floor is fully accessible to wheelchair users, prams and people with limited mobility

The practice employs three dentists, one hygienist, three dental nurses of which one is a trainee, one receptionist and a practice manager. The practice’s opening hours are 9am to 1pm and 2pm to 5.30pm Monday to Friday. There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service run by a number of local dentists who operate an on-call system.

The practice manager 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.

The inspection was carried out by a CQC inspector.

Our key findings were:

• Infection control procedures followed published guidance under the Health and Social Care Act 2008.

• Staff recruitment files contained essential information in relation to Regulation 19, Schedule 3 of Health & Social Care Act 2008 (Regulated Activities) Regulations 2015.

• Staff had received appraisals and training appropriate to their roles.

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

Background

Avenue House Dental Practice is a dental practice providing private treatment for both adults and children.

The practice is situated in Lymington town centre. The practice has five dental treatment rooms, of which four are in use, and a separate decontamination room used for cleaning, sterilising and packing dental instruments. The practice is based on the ground and first floor of a former detached domestic dwelling. The ground floor is fully accessible to wheelchair users, prams and people with limited mobility

The practice employs three dentists, one hygienist, three dental nurses of which one is a trainee, one receptionist and a practice manager. The practice’s opening hours are 9am to 1pm and 2pm to 5.30pm Monday to Friday. There are arrangements in place to ensure patients receive urgent medical assistance when the practice is closed. This is provided by an out-of-hours service run by a number of local dentists who operate an on-call system.

The practice manager 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.

We obtained the views of 14 patients on the day of our visit.

The inspection was carried out by a lead inspector and a dental specialist adviser.

Our key findings were:

• Staff had been trained to handle emergencies and appropriate medicines and life-saving equipment was readily available in accordance with current guidelines.

• The treatment rooms in use and other public areas of the practice appeared clean and maintained although some areas of the practice were cluttered.

• Infection control procedures generally followed published guidance however; the practice did not audit the effectiveness of their infection control systems and processes with the Code of Practice on the prevention and control of infections and related guidance under the Health and Social Care Act 2008

• The practice had a safeguarding lead with processes in place for safeguarding adults and children living in vulnerable circumstances.

• Although the practice generally followed national guidance for radiation used in dental practice, the maintenance of the X-ray sets was not carried out in accordance with current Ionising Radiation Regulations 1999. We have since received evidence to confirm this has since been addressed.

• Staff reported accidents and kept records of these which the practice used for shared learning. However, the practice did not have systems in place to receive national safety alerts and record incidents under RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013).

• Dentists provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines

• The service was aware of the needs of the local population and took these into account in how the practice was run.

• Patients could access treatment and urgent and emergency care when required.

• The practice reviewed and dealt with complaints according to their practice policy.

There were areas where the provider must:

• Ensure audits of various aspects of the service, such as radiography, infection control and dental care records are undertaken at regular intervals to help improve the quality of service. The practice should also ensure that where appropriate all audits have documented learning points and the resulting improvements can be demonstrated.

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

• Ensure the training, learning and development needs of individual staff members are reviewed at appropriate intervals and an effective process is established for the on-going assessment and supervision of all staff.

• Ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).

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

• Review the storage of environmental cleaning materials and equipment so they follow published guidelines.

• 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).

• Declutter treatment rooms and storage areas of the practice.

• Consider providing the hygienist with the chair side support of a dental nurse.

• Consider installing a hearing loop and language interpreting facilities.