We carried out a focused inspection of Barley Mow Dental Practice on 20 March 2018.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 18 September 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

At a comprehensive inspection we always ask the following five questions to get to the heart of patients’ experiences of care and treatment:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

When one or more of the five questions is 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.

At the previous comprehensive inspection we found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations. We judged the practice was not providing well-led care in accordance with 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 Barley Mow Dental Practice on our website www.cqc.org.uk.

We also reviewed the key questions of safe and responsive as we had made recommendations for the provider relating to these key questions. We noted that improvements had been made.

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 to put right the shortfalls and deal with the regulatory breach we found at our inspection on 18 September 2017.

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

The provider had made improvements to put right the shortfalls and had dealt with the regulatory breach we found at our inspection on 18 September 2017.

We carried out this announced inspection on 18 September 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 who was supported by a specialist dental adviser.

We told the NHS England area team and Healthwatch that we were inspecting the practice. They did not provide any information.

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

Barley Mow Dental Practice is in Malmsbury and provides private treatment to patients of all ages and NHS treatment to children only.

There is level access for patients who use wheelchairs and pushchairs. Car parking spaces can be on roads near the practice. There are no parking spaces identified for patients with disabled badges.

The dental team includes three dentists, six dental nurses, three dental hygienists, and three receptionists. 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 48 CQC comment cards filled in by patients and spoke with two other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, three dental nurses, and two receptionists. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

• Monday – Wednesday 8.30am – 5.15pm
• Thursday 08.30am – 6.45pm Friday 8.30am – 1.00pm

It is closed at weekends and out of hours information is available on the website.

Our key findings were:

• The practice appeared clean and well maintained.
• The practice 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 systems to help them manage risk but they were not always operated effectively.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice recruitment procedures did not meet the legislative requirements for the safe recruitment of staff.
• 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.
• The appointment system met patients’ needs.
• The practice had mostly effective leadership but it did not ensure staff completed all required continuing professional development through appraisal.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The practice dealt with complaints positively and efficiently.

We identified regulations the provider was not meeting. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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

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

• Review their responsibilities with regard to the Control of Substances Hazardous to Health (COSHH) Regulations 2002 and ensure all documentation including product sheets are available and staff understand how to minimise risks associated with the use and handling of these substances.
• Review its responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010.

We spoke with ten people as they were leaving after their appointment. Some described the practice as “excellent” and “very good”. One person said their dentist was “marvellous” and that “nothing is too much trouble”. A person who had visited for the first time thought it was a “nice practice” and another, whose family had moved to a different area, said the whole family travel back to the practice for treatment. Dentists said this was not uncommon and they saw people from as far away as Hereford and the Isle of Wight.

A person whose children also attended for treatment said their children were “treated well” adding the dentist was “brilliant” with their child who had special needs. Another parent told us their children had attended in the previous week and everything had “gone well”.

People told us they were consulted and given information about their treatment. There were arrangements to ensure that people’s care and treatment were suitable including equipment and medicines for medical emergencies. People were protected because the provider made suitable arrangements to protect them and staff knew what they should do if they suspected abuse. There were good systems for the control and prevention of infection. Staff told us they felt supported and we saw they had a range of training opportunities. There were a range of audits and checks conducted to maintain quality in the practice.