We carried out a follow- up inspection at Bank Parade Dental Practice on the 24 July 2017.

We had undertaken an announced comprehensive inspection of this service on the 25 October 2016 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection, the practice manager wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to that requirement.

We reviewed the practice against one of the five questions we ask about services: is the service safe and well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bank Parade Dental Practice on our website at www.cqc.org.uk.

We revisited Bank Parade Dental Practice as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We carried out this unannounced inspection on 24 July 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 with remote support from a specialist dental adviser.

Our findings were:

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

Background

Bank Parade Dental Practice is situated in close to Burnley town centre, Lancashire. The practice offers mainly NHS dental treatment but also offers private treatments. The practice has three surgeries; one located on the ground floor and two on the first floor. There is a dedicated decontamination area, a reception area, waiting rooms on the ground and first floor and a patient toilet.

There is one dentist, a dental hygienist and three dental nurses who also undertake receptionist duties.

The practice is open: Monday to Friday  9am-5pm.

The practice is owned by an individual. 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.

Our key findings were:

• The COSHH file had been updated.
• The Radiation Protection File was complete.
• There was a recruitment policy and procedure in place and robust checks completed on staff.
• A robust system was in place for dealing with complaints.
• Paper dental records were now stored securely.
• Risk assessments were in place to assess the risks to patients and staff including, fire, and the use of sharps.
• An Infection Prevention audit was completed.
• The electrical safety assessment was in place.

The practice had also acted upon other recommendations:

• A review of the decontamination area was completed to determine if the security is sufficient and the area fit for its intended purpose.
• A review and risk assessment for legionella was in place and actions in place to minimise risk.

We carried out an announced comprehensive inspection on 25 October 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 not providing well-led care in accordance with the relevant regulations.

Background

Bank Parade Dental Practice is situated in close to Burnley town centre, Lancashire. The practice offers mainly NHS dental treatment but also offers private treatments. The practice has three surgeries; one located on the ground floor and two on the first floor. There is a dedicated decontamination area, a reception area, waiting rooms on the ground and first floor and a patient toilet.

There is one dentist, a dental hygienist and three dental nurses who also undertake receptionist duties. The practice is open Monday to Friday 09:00 – 17:00. It is closed for lunch between 13:00 and 14:00.

The practice owner 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.

During the inspection we spoke with four patients who used the service and reviewed 14 completed CQC comment cards. The patients were positive about the care and treatment they received at the practice. Patients commented that staff provided a high quality service in a friendly and professional way.

Our key findings were

• The clinical areas of the practice were visibly clean.
• There were sufficient numbers of suitably qualified staff to meet the needs of patients.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks, and were involved in making decisions about their treatment.
• Patients were treated with dignity and respect.
• The appointment system met patient’s needs.
• The practice sought feedback from patients about the service and it gave us a positive picture of a friendly, professional and responsive service.
• There were clearly defined roles within the practice.
• Staff said they worked well together as a team.
• Staff were supported in their continued professional development (CPD).
• An incident management policy and procedure was not in place.
• The COSHH file had not been reviewed or updated.
• There was no recruitment policy and procedure in place.
• There was not a robust system in place for dealing with complaints.
• The governance system was inadequate, including the portfolio of practice policies and audit activity.
• Paper dental records were not stored securely.
• The practice had insufficient risk assessments in place to assess the risks to patients and staff including, fire, environmental risks and sharps.

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

• 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 the local procedure and contacts for reporting a safeguarding concern is made available to staff.
• Ensure that a system for identifying, receiving, recording, handling and responding to complaints by patients is established.
• Ensure that the practice reviews current policies and procedures to ensure they reflect current guidelines and develops policies that are not in place, including those related to: whistle blowing, incident management and equality and diversity.
• Ensure a risk assessment is carried out of the designated area for the decontamination to determine if the security is sufficient and the area fit for its intended purpose.
• Ensure the COSHH file for hazardous materials is reviewed to ensure it is up-to-date and risk assessments are in place for all hazardous materials used or stored at the premises.

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 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.
• Review the practice’s protocols for the use of rubber dam advised for use during root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the current legionella risk assessment and implement the required actions including, the monitoring and recording of water temperatures, giving due regard to the 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

People using the service told us they were satisfied with the care and treatment they received at Bank Parade Dental Practice. One person said, “It’s the best dentist I’ve been to. I’m really pleased.” Another person said, “They’re good with the children, I wouldn’t go anywhere else.”

People said the dentist discussed treatment options with them including the cost. One person said, “The dentist explained the treatment I needed and the cost involved.”

All the people we asked said the dental nurses were helpful. One person said, “I get on well with all the staff.”

Information about the treatments available and their cost was displayed in the waiting room.