We undertook a focused inspection of Avon House Dental Practice on 25 March 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector.

We undertook a comprehensive inspection of Avon House Dental Practice on 29 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

We found the registered provider was not providing well led care and was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for Avon House Dental Practice on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan. We then inspect again after a reasonable interval, focusing on the areas where improvement was required.

Our findings were:

Are services well-led?

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

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 29 October 2018.

Background

Avon House Dental Practice is in Keynsham and provides NHS and private treatment to adults and children.

There is no level access for people who use wheelchairs and those with pushchairs as the practice is on the first floor. Twin hand rails are provided on the staircase leading up to the practice. At the bottom of the stairs is a door bell and notice for anyone needing assistance on the stairs to use to alert the staff on reception. Car parking spaces are available near the practice.

The dental team includes two dentists and a foundation dentist, three dental nurses and one trainee dental nurse, one dental hygiene therapist, one receptionist 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.

During the inspection we spoke with the principal dentist, one dental nurse, one receptionist 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 – Friday 09.00am – 1.00pm and 2.00pm – 5.45pm

• Closed at weekends.

Our key findings were:

• The practice had systems to help them manage risk to patients and staff.
• The provider had comprehensive safeguarding processes. Staff had received training and knew their responsibilities for safeguarding vulnerable adults and children. They were clear about the need to have written evidence of a third party to consent to treatment for a child or vulnerable adult.
• The provider had reviewed the management of the practice and there was effective leadership and a culture of continuous improvement.

We carried out this announced inspection on 29 October 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.

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 this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

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

Background

Avon House Dental Practice is in Keynsham and provides NHS and private treatment to adults and children.

There is no level access for people who use wheelchairs and those with pushchairs as the practice is on the first floor. Twin hand rails are provided on the staircase leading up to the practice. At the bottom of the stairs is a door bell and notice for anyone needing assistance on the stairs to use to alert the staff on reception. Car parking spaces are available near the practice.

The dental team includes two dentists and a foundation dentist, three dental nurses and one trainee dental nurse, one dental hygiene therapist, one receptionist 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 collected 50 CQC comment cards filled in by patients and spoke with two other patients.

During the inspection we spoke with two dentists and the foundation dentist, three dental nurses, one receptionist 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 – Friday 09.00am – 1.00pm and 2.00pm – 5.45pm
• Closed at weekends.

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had some systems to help them manage risk to patients and staff but they were not robust. For example, the fire risk assessment and the health and safety risk assessment of the practice.
• The provider had safeguarding processes but they were not comprehensive. Staff had received training and mostly knew their responsibilities for safeguarding vulnerable adults and children. They were not clear about the need to have written evidence of a third party to consent to treatment for a child or vulnerable adult.
• The provider had suitable staff recruitment procedures.
• 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.
• The appointment system took account of patients’ needs.
• The provider had effective leadership and culture of continuous improvement but more work was required to ensure good governance of the practice.
• 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.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care especially with regard to significant event reporting, recording and management.
• Ensure systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities are completed by competent persons in particular fire and legionella.

Full details of the regulation the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the practice sharps procedures to ensure the practice is compliant with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• Review the practice protocol for ensuring all clinical staff have adequate immunity from vaccine preventable infectious diseases.
• Review the practice protocols for medicines management and ensure all medicines are stored and dispensed safely and securely.
• Review the process for checking the automated external defibrillator (AED) in the practice taking into account the guidelines issued by the Resuscitation Council UK and the General Dental Council.
• Review the suitability of the premises and ensure all areas are fit for the purpose for which they are being used. In particular the situation and entrance to the decontamination area.
• Review the practice arrangements for ensuring good governance and leadership are sustained in the longer term.