We carried out a focused inspection of Bassingbourn Dental Practice on 29 January 2018.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 9 May 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 area(s) 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 Bassingbourn Dental Practice on our website www.cqc.org.uk.

We also reviewed aspects of the key questions of safe as we had made recommendations for the provider relating to this key question.

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 correct the shortfalls and address the regulatory breach we found at our inspection on 9 May 2017.

We carried out this announced inspection of Bassingborn Dental Practice 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. A CQC inspector, who was supported by two specialist dental advisers, led the inspection.

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

Bassingborn Dental Practice is a well-established practice based in the village of Bassingbourn that provides mostly NHS treatment to patients of all ages, although has a predominance of older patients.

The dental team includes two dentists, two dental nurses, one dental hygienist and a receptionist. A clinical co-ordinator, who is a registered dentist from another practice, helps with administration when needed. The practice has two treatment rooms and is open on Mondays and Tuesdays from 8.30am to 5pm; on Wednesdays from 8am to 6pm, on Thursdays from 8am to 5pm, and on Fridays from 8am to 1pm.

There is level access for people who use wheelchairs and those with pushchairs, but no disabled toilet facilities.

The practice 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 Bassingbourn Dental Practice is the principal dentist and owner.

On the day of our inspection we collected 14 comment cards filled in by patients and spoke with two other patients. This information gave us a very positive view of the practice.

During the inspection we spoke with the principal dentist, the clinical co-ordinator and two dental nurses. We looked at the practice’s policies and procedures, and other records about how the service was managed.

Our key findings were:

• We received consistently good feedback from patients about the quality of the practice’s staff and the effectiveness of their treatment.

• Appointments were easy to book and patients requiring urgent treatment were always seen on the same day.

• The practice had suitable safeguarding processes and staff knew their responsibilities for protecting adults and children.

• Members of the dental team were up-to-date with their continuing professional development and supported to meet the requirements of their professional registration.

• Staff we spoke to felt well supported by the practice owner, and there were regular practice meetings involving all staff. The practice listened to its patients and staff and acted upon their feedback.
• Risk assessments were not robust enough to ensure that patients and staff were adequately protected
• The practice’s sharps handling procedures and protocols did not comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Essential information and evidence of some dental examinations and risk assessments was missing from patient dental care records.

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

• Ensure effective systems and processes are established to assess and monitor the service against the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and national guidance relevant to dental practice. This includes the recording and monitoring significant events; ensuring appropriate medical emergency equipment is available, ensuring staff recruitment is effective, implementing robust risk assessment, and improving the management of sharps. The practice must also ensure dental care records are maintained appropriately giving due regard to guidance provided by the Faculty of General Dental Practice regarding clinical examinations and record keeping.

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

• Review the storage of medicines to ensure they are kept according to guidance.

We spoke with for people during our inspection who each told us they were satisfied with all aspects of their care and treatment. They told us they felt they had been shown respect and said that staff were polite and friendly. One person said " I am satisfied that my treatment is right for me". Another person said, “I always know how much my treatment will cost me".

People's clinical records showed they had been included and involved in making decisions about their treatment and that comprehensive records of their care had been recorded.

The practice was carrying out appropriate infection control processes to ensure people were not placed at risk of cross infection.

The practice had taken suitable steps to ensure children and vulnerable people would be protected from abuse.

The premises were comfortable and clean.