We undertook a focused inspection of Barton Dental Surgery on 20 September 2018. 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 Barton Dental Surgery on 15 February 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 in accordance with the relevant regulations 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 Barton Dental Surgery on our website www.cqc.org.uk.

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 area where improvement was required.

As part of this inspection we asked:

• Is it well-led?

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 breach we found at our inspection on 15 February 2018.

Background

The practice is located in Barton Le Clay in central Bedfordshire. It provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. There are no patient car parking facilities available; although patients with disabilities can be offered a space in the practice’s private car park. Public roadside car parking is available within a short walking distance of the practice.

The dental team includes three dentists, four dental nurses (including the head nurse), one trainee nurse, one dental hygienist and one receptionist. The head nurse was also undertaking management duties and had taken on the role of practice coordinator.

The practice has three treatment rooms; two of these are on the ground floor.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Barton Dental Surgery is one of the dentists who owns the practice.

We were advised on the day of our comprehensive inspection that two of the four partners had left. We told the principal dentist to take action to ensure the CQC registration of the practice is correct. We found that the registration of the practice was still not correct at the time of our follow up visit. The dentist who owns the practice told us they had been making efforts to resolve the issues.

The practice is open: Monday, Tuesday, Wednesday, Thursday from 8.30am to 4.30pm and Friday from 8.30am to 2pm. The practice is closed at lunchtimes from 1pm to 2pm Monday to Wednesday and from 2pm to 3pm on Thursday.

Our key findings were:

• The practice had implemented a policy and process for reporting and investigating significant events.

• The practice had improved systems for monitoring and improving quality, for example audit activity.

• A policy for safeguarding vulnerable adults had been implemented.

• A risk assessment had been conducted for the non-clinical staff member working without disclosure barring service (DBS) check clearance. The practice had ensured that clinical staff had a DBS check in place.

• A policy had been implemented regarding staff employment and recruitment. We saw that policy was being applied in relation to the appointment of new staff.

• The practice had implemented a system for the review and action of patient safety and medicines alerts from the Medicines and Healthcare Products Regulatory Authority (MHRA).

• The risks presented by legionella and fire were being effectively addressed.

• The practice had obtained rectangular collimators for their X-ray equipment.

• The practice had started to take steps by encouraging clinicians to follow the guidelines issued by the British Endodontic Society regarding the use of rubber dam.

• Waste handling protocols had been reviewed and now reflected guidance issued in the Health Technical Memorandum 07-01 (HTM07-01).

• Prescription pad security had been improved.

• Staff were up to date with their mandatory training and continuing professional development (CPD).

• Staff had completed or were in the process of completing training in the Mental Capacity Act (MCA) 2005.

• The practice had not yet taken action regarding the installation of a hearing loop to assist those who used a hearing aid. An external agent was due to undertake a risk assessment of the premises.

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

• Review the practice's responsibilities to take into account the needs of patients with disabilities and to comply with the requirements of the Equality Act 2010.

We carried out this announced inspection on 15 February 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 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

The practice is located in Barton Le Clay in central Bedfordshire. It provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. There are no patient car parking facilities available; although patients with disabilities can be offered a space in the practice’s private car park. Public car parking is available on street within short walking distance of the practice.

The dental team includes three dentists, three dental nurses (including the head nurse), one trainee nurse, one dental hygienist and one receptionist. The head nurse was also undertaking management duties and had taken on the role of practice coordinator.

The practice has three treatment rooms; two of these are on the ground floor.

The practice is owned by a partnership and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Barton Dental Surgery is one of the dentists who owns the practice.

We were advised on the day of our inspection that two of the four partners had left. We have told the principal dentist to take immediate action to ensure the CQC registration of the practice is correct.

On the day of inspection we collected 20 CQC comment cards filled in by patients. This information gave us a positive view of the practice.

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

The practice is open: Monday, Tuesday, Wednesday, Thursday from 8.30am to 4.30pm and Friday from 8.30am to 2pm. The practice is closed at lunchtimes from 1pm to 2pm Monday to Wednesday and from 2pm to 3pm on Thursday.

Our key findings were:

• The practice objectives included the provision of quality treatment in a friendly atmosphere and the maintenance of patients’ oral health to prevent new diseases from occurring.
• Staff had been trained to deal with medical emergencies. We found some items of equipment and medicines required in the event of a medical emergency were missing. An order was placed for the items immediately after our inspection.
• The practice appeared clean and well maintained, although no formal monitoring of arrangements were in place.
• Safeguarding arrangements required improvement to ensure all staff maintained up to date training. Policy provision was required in relation to vulnerable adults.
• The practice had not adopted an effective process for the reporting and investigating of untoward incidents and ensuring shared learning.
• Clinical staff provided dental care in accordance with current professional and National Institute for Care Excellence (NICE) guidelines.
• We found that not all patients’ different needs were identified. The practice did not have a hearing loop or access to information in different formats.
• Patients had access to routine treatment and emergency care when required.
• Staff had received some training appropriate to their roles; there was evidence of continuing professional development (CPD).
• The practice had processes to deal with complaints efficiently.
• We found leadership and governance arrangements required significant strengthening.

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.

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 the practice’s protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.
• Review the practice's waste handling protocols to ensure waste is segregated and disposed of in accordance with relevant regulations taking into account guidance issued in the Health Technical Memorandum 07-01 (HTM 07-01).
• Review the security of prescription pads in the practice and ensure there are systems in place to track and monitor their use.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development (CPD).
• Review staff awareness of the requirements of the Mental Capacity Act (MCA) 2005 and ensure all staff are aware of their responsibilities under the Act as it relates to their role.
• Review its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.