We carried out a follow up inspection at B E Perry Dental - Ripon Road on the 7 February 2017.

We had undertaken an announced comprehensive inspection of this service on the 20 September 2016 as part of our regulatory functions where breaches of legal requirements were found.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to each of the breaches. This report only covers our findings in relation to those requirements.

We reviewed the practice against one of the five questions we ask about services: is the service safe?

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for B E Perry Dental - Ripon Road on our website at www.cqc.org.uk.

We revisited the B E Perry Dental - Ripon Road as part of this review and checked whether they had followed their action plan and to confirm they now met the legal requirements.

Our findings were:

Are services well-led?

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

Background

B E Perry Dental Limited is situated in the town centre of Harrogate, North Yorkshire. The practice offers private dental treatment including preventative advice, dental implants restorations and cosmetic dentistry.

The practice has three surgeries located on the ground floor, a decontamination room, a waiting area, a reception area to welcome patients and patient toilets. There are staff facilities and offices in the basement of the premises.

There is one dentist, two dental nurses (one of which is the receptionist) and a dental hygienist.

The practice is open:

Monday, Wednesday and Friday 09:00 – 17:30. The practice closes for lunch between 12:30 and 14:00. Tuesday & Thursday 09:00 – 12:30.

The practice owner 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.

Our key findings were:

• The practice had undertaken a Legionella risk assessment and have implemented 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’.
• The practices had completed sharps handling procedure and protocols in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• The practice's had reviewed their recruitment policy and procedures ensuring they 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.
• The practice had established a system for identifying, receiving, recording, handling and responding to complaints by patients.
• The staff had reviewed their responsibilities in 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. A risk assessment for each material used within the practice was now in place.

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 safeguarding policy; ensuring it covers both children and adults.

We carried out an announced comprehensive inspection on 15 September 2016 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

B E Perry Dental Limited is situated in the town centre of Harrogate, North Yorkshire. The practice offers private dental treatment including preventative advice, dental implants restorations and cosmetic dentistry.

The practice has three surgeries located on the ground floor, a decontamination room, a waiting area, a reception area to welcome patients and patient toilets. There are staff facilities and offices in the basement of the premises.

There is one dentist, two dental nurses (one of which is the receptionist) and a dental hygienist.

The practice is open:

Monday, Wednesday and Friday 09:00 – 17:30. The practice closes for lunch between 12:30 and 14:00.

Tuesday & Thursday 09:00 – 12:30.

The practice owner 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.

On the day of inspection we received feedback from 11 patients. The patients who provided feedback were very positive about the care and attention to treatment they received at the practice. They told us they were involved in all aspects of their care and found the staff to be welcoming, patient, friendly and caring. Patients commented they could access emergency care easily and they were treated with dignity and respect in a clean and tidy environment.

Our key findings were:

• The practice was visibly clean and uncluttered.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Infection control procedures were in accordance with the published guidelines.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients were treated with dignity and respect and confidentiality was maintained.
• The appointment system met patients’ needs.
• The practice sought verbal feedback from staff and patients about the services they provided.
• There were clearly defined leadership roles within the practice.
• There were some gaps in the practice’s recruitment procedure.
• There was not a robust system in place for dealing with complaints.
• The governance systems were inadequate.

There were areas where the provider could make improvements and 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’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.
• 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 that a system for identifying, receiving, recording, handling and responding to complaints by patients is established.

You can see full details of the regulation 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 practice’s protocols for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society
• 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.
• Implement a practice’s safeguarding policy ensuring it covers both children and adults.
• Review that practice policies ensuring they are in line with current guidelines and legislation.
• Review the practice audit protocols to document learning points are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.

People told us that they were very satisfied with the care and attention they were receiving at this dental practice