We undertook a focused inspection of Bilborough dental practice on 21 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 who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Bilborough dental practice on 30 May 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 Bilborough dental practice 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 30 May 2018.

Background

Bilborough Dental Practice is in Nottingham and provides mainly NHS dental treatment to both adults and children.

There is level access into the practice with a sliding automatic door. This is particularly of benefit for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in the practice car park.

The dental team includes three dentists, one qualified dental nurse, two trainee dental nurses, and one practice manager. The practice has three treatment rooms, two on the ground floor.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission (CQC) 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. At the time of the inspection the practice manager was awaiting their interview with CQC to become the registered manager.

On the day of inspection, we received feedback from 16 patients.

During the inspection we spoke with the practice manager and an area manager representing the provider. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open: Monday: 8.30am to 5:30pm, Tuesday: 8am to 8pm, Wednesday: 8.30am to 5:30pm, Thursday: 8am to 8pm and Friday: 8.30am to 5:30pm, Saturday: 9am to 1pm. The practice is closed on Sunday.

Our key findings were:

• The provider had reviewed the systems and processes for completing audits within the practice, particularly in respect of infection control, dental care records and radiography.

• The practice was holding regular staff meetings and recording the outcome of those meetings.

• The provider had reviewed the way in which incidents related to the duty of candour were managed.

• The practice had begun a process to ensure all staff members had an appraisal of their performance by the practice manager.

• The provider was in the process of ensuring there was a registered manager at the practice. The practice manager had an interview scheduled with the Care Quality Commission to become the registered manager of the service.

We carried out this announced inspection on 30 May 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

Bilborough Dental Practice is in Nottingham and provides mainly NHS dental treatment to both adults and children.

There is level access into the practice with an automatic door. This is particularly of benefit for people who use wheelchairs and those with pushchairs. Car parking spaces, including spaces for blue badge holders, are available in the practice car park.

The dental team includes three dentists, one qualified dental nurse, and four trainee dental nurses. The practice has three treatment rooms, two on the ground floor.

The practice is owned by a company 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. At the time of the inspection the practice did not have a registered manager in post.

On the day of inspection, we received feedback from 16 patients.

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

The practice is open: Monday: 9am to 7:30pm, Tuesday: 8am to 5:30pm, Wednesday: 9am to 7:30pm, Thursday: 7:30am to 12:30pm and Friday: 9am to 5:30pm. The practice is closed for lunch 12:30pm to 1:45pm. The practice is closed on Saturday and Sunday.

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.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children.
• The practice had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Dentists had not always used rubber dam in the past when carrying out root canal treatment. This was not in line with guidance from the British Endodontic Society.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The practice was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had not had a practice manager in post for most of the 18 months up to this inspection.
• 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.
• Governance arrangements at the practice had been ineffective in the year up to this inspection.
• The practice had been without a registered manager since January 2018.

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 a registered manager is appointed.

Full details of the regulation 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 policy for the control and storage of substances hazardous to health identified by the Control of Substances Hazardous to Health Regulations 2002, to ensure risk assessments are undertaken and the products are stored securely.

• Review the security of NHS prescription pads in the practice and ensure there are systems in place to track and monitor their use.

We spoke to two patients with their consent and three members of staff during our visit.

We found patients were treated with dignity and respect. One patient said, “This is my first time I have visited here. They are very polite and friendly.” We saw patients were welcomed to the practice by staff and they spoke to them in a calm and respectful manner.

We found information was available for patients use to keep them fully informed. Patients told us they received enough information regarding their care and treatment to help them make informed choices.

Patients told us they were involved in discussions with the dentists regarding the care they received. We found each patient had received a treatment plan and that the dentist undertook full mouth assessments to ensure patients' oral health was maintained.

We found the practice to be clean and the surgeries to be well stocked with personal protective equipment. Patients were aware that staff wore protective clothing when delivering their care.

We found suitable access for patients with mobility difficulties and there were systems in place for people who were hearing impaired.

We saw copies of staff training certificates and supervision documents to ensure they were supported to do their job. Staff confirmed they were encouraged to develop their skills and knowledge.

We found systems in place to monitor the service the practice provided and ensure patients were kept safe.