We carried out an announced comprehensive inspection of this practice on 17 May 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to safe care and treatment and good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ballard And Tucker Limited on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

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

Background

Ballard and Tucker Limited is a dental practice providing general dental treatment and some specialist dental treatment in Biggleswade, Bedfordshire. Treatment is provided on the NHS, but is mostly paid for privately.

The practice is located over two floors of a purpose built building. The main reception is situated downstairs along with three treatment rooms. The other two treatment rooms are situated upstairs. Access to the upstairs area is via an external door and could not be made through the building.

The practice is open from 8.30 am to 5.30 pm Monday to Friday.

Access for urgent treatment outside normal opening hours is by following the instruction displayed on the door, and explained on the answerphone, or by telephoning the NHS 111 service.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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:

• Improvements were seen in all areas where concerns had been highlighted in the comprehensive inspection.

• Clinical audit was used effectively to highlight areas where improvements could be made.
• Medicines and equipment to treat medical emergencies were in line with national guidance and kept together.
• Pre-employment checks were carried out in line with regulation.

• Appropriate documentation pertaining to substances hazardous to health was kept in the practice.

• Policies to aid the smooth running of the service had been updated and signed by staff since our last visit to the practice.

We carried out an announced comprehensive inspection on 17 May 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

Ballard and Tucker Limited is a dental practice providing general dental treatment and some specialist dental treatment in Biggleswade, Bedfordshire. Treatment is provided on the NHS, but is mostly paid for privately.

The practice is located over two floors of a purpose built building. The main reception is situated downstairs along with three treatment rooms. The other two treatment rooms are situated upstairs. Access to the upstairs area is via an external door and could not be made through the building.

The practice is open from 8.30 am to 5.30 pm Monday to Friday.

Access for urgent treatment outside normal opening hours is by following the instruction displayed on the door, and explained on the answerphone, or by telephoning the NHS 111 service.

The principal dentist is registered with the Care Quality Commission (CQC) as an individual. 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 received feedback from 29 patients about the services provided, this was mostly positive, and praised the friendly and caring nature of the staff.

Our key findings were:

• The practice was visibly clean and clutter free.

• Patients were treated with care and compassion; patients with children commented on how comfortable their children felt to attend the practice.

• The practice had medicines in place to deal with medical emergencies that might arise, and had an automated external defibrillator which was regularly checked.

• Treatment options were identified and discussed with patients. Models and picture aids were used to illustrate discussions.

• Staff had a good understanding of how and when to raise a safeguarding concern.

• The practice had policies in place to aid the smooth running of the service, although these had not all been recently reviewed.

• Dentists used nationally recognised guidance to aid in the care and treatment of patients.

• Governance protocols to ensure the continuing improvement of the service were not as robust as they could be. Certain required clinical audit had not been completed such as infection control.

• Some dental care records were not stored securely; patients were unsupervised in areas where they were stored.

• There was appropriate equipment for staff to undertake their duties, and equipment was well maintained.

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

• Ensure care and treatment is provided in a safe way by assessing the risk of the spread of infection by carrying out infection control audits at regular intervals as described in Health Technical Memorandum 01-05 (HTM 01-05).

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities: for example by the effective use of clinical audit and risk assessment.

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 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), and the General Dental Council (GDC) standards for the dental team.

• 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 the practice’s staff awareness and training in safeguarding vulnerable adults, child protection, Gillick competency and the requirements of the Mental Capacity Act (MCA) 2005.Ensure all staff are trained to an appropriate level for their role and aware of their responsibilities.

• Review the protocol for completing accurate, complete and detailed records relating to employment of staff. This includes making appropriate notes of verbal reference taken and ensuring recruitment checks, including references, are suitably obtained and recorded.

• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development.

During our inspection on 22 February 2013 we spoke with four people who told us they were satisfied with their care and treatment and that they had been spoken to politely by reception and dental staff whenever they attended the practice. They told us that the dentist had given them appropriate explanations and information about their treatment and that dental staff were polite and respectful.

Care records showed people had been included in decision making and that their treatment had been adequately recorded.

Staff had received safeguarding training. The policies for safeguarding children and for vulnerable adults did not include the correct reporting arrangements that should be in place and did not refer to the Local Authority published guidelines.

We found suitable and appropriate infection control process were in place to ensure people were not exposed to the risks of cross infection and that the appropriate published guidelines had been followed.

The premises were clean and had been well maintained. We saw that there were suitable arrangements in place to reduce the risks of fire.