We carried out a focused inspection of Bell Green Dental Surgery on 20 June 2018.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser and a second CQC inspector. We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 21 November 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 Berry Lane Dental Clinic on our website www.cqc.org.uk.

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

Our key findings were:

• The practice had implemented a system to manage the risk of Legionella bacteria.
• The practice had implemented a system to oversee staff training.
• The practice had implemented a process of effective clinical audit to promote continuous improvement.
• The practice had implemented systems to manage the risks arising from the use of hazardous substances. We found that there remained scope to expand this further to ensure all risks were managed.
• The practice had a system to manage the risk arising to staff whose immunity to Hepatitis B could not be assured.

The provider had made improvements to put right the shortfalls and deal with the regulatory breach we found at our inspection on 21 November 2017.

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

• Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from the undertaking of the regulated activities. In particular regarding the control of substances hazardous to health.

We carried out this announced inspection on 21 November 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.

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

Bell Green Dental Surgery is in Coventry and provides NHS and private treatment to patients of all ages.

There is level access for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes three dentists, two dental nurses that also work as receptionists and two dental nurses that also take on the responsibility of practice management. 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 22 CQC comment cards filled in by patients and spoke with one other patient. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, one dental nurse who worked on reception and two dental nurses / practice managers.

We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Friday from 9am to 5pm

Saturday and Sunday from 10am to 12pm

Our key findings were:

• The practice was clean and mostly well maintained. Some areas of the practice would benefit from remedial work to improve ability to clean.
• The practice was open every day of the year to meet the needs of patients.
• The practice had infection control procedures which mostly reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available. Training in basic life support could not be demonstrated for all staff in the year preceding the inspection.
• The practice had some systems to help them manage risk. Some required risk assessments for example: a Legionella risk assessment was not completed at the time of the inspection. Other risk assessments were not used effectively to monitor and mitigate risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had mostly thorough staff recruitment procedures. They did not always record references.
• 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.
• 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. The displayed complaints policy did not contain details of external companies that patients could raise complaints with. This was amended following the inspection.

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 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 staff training & availability of equipment to manage medical emergencies taking into account guidelines issued by the Resuscitation Council (UK) and the General Dental Council (GDC) standards for the dental team.

• Review availability of an interpreter services for patients who do not speak English as a first language.

People spoken with were happy with the service they received. One person said, “I have been coming to see the same dentist here for years. All the staff are really friendly and welcoming.” Another person said “I have moved to a different area of the city and still travel here to use this dentist. I know their faces and they are all so friendly.”

People we spoke with said everything always looked clean. People confirmed that the dentists and nurses always offered them glasses to protect their eyes during treatment. We were told the dentists wore these themselves and that he always wore disposable gloves.

People told us, “The dentist I see is extremely gentle and professionally he is exceptionally good." Another person told us. “I am a very nervous patient actually I’m petrified visiting the dentist. I come here because they are brilliant. They talk to me all the time to distract me, the nurse even holds my hand which is so reassuring.”

We asked if there was anything else people would like to tell us about the surgery. One person said, “I would like to say that I like the fact that there is a seven day service, you don’t often find that. You are treated with the same dignity and respect if you are national health or a private patient.”

We asked dental staff how the surgery decides on a treatment plan with a person. We were told this would depend on the oral health assessment that is completed at the start of each course of treatment. We were shown a completed assessment and the dentist showed us a treatment plan on the computer in his treatment room. People we spoke with told us everything was always explained to them. One person told us "If there are any treatment options we discuss these and make a decision together.”

Staff spoken with told us that they had attended training in the decontamination of equipment and infection control. Staff said they felt confident with this procedure. We observed the decontamination process and the nurse described how the equipment was monitored to ensure it was working efficiently. We did find some out of date packages of instruments and the nurse took immediate action to re-sterilise these, so there was no risk to patients.

We looked at the records held on staff including their personal information and saw that this could be stored more securely. The manager and dentist said they would move records to a lockable cabinet to maintain confidentiality.

The practice does not currently undertake a survey of patient’s views of the service they receive. We discussed this with the manager who said that she was looking at introducing a ‘comments box’ into the waiting room.

We asked if people had ever had to make a complaint. People we spoke with said they would speak to the dentist if they were unhappy with anything but had never had cause to do this.