We carried out a follow- up inspection at Bilton Dental Practice on the 13 July 2017.

We had undertaken an announced comprehensive inspection of this service on the 31 May 2017 as part of our regulatory functions where a breach of legal requirements was found.

After the comprehensive inspection, the practice manager wrote to us to say what they would do to meet the legal requirements in relation to the breach. This report only covers our findings in relation to that requirement.

We reviewed the practice against one of the five questions we ask about services: is the service safe and well led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bilton Dental Practice on our website at www.cqc.org.uk.

We revisited Bilton Dental Practice as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements. We carried out this unannounced inspection on 13 July 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.

• Is it well-led?

This question forms the framework for the areas we look at during the inspection.

Our findings were:

Are services well-led?

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

Background

Bilton Dental Practice is located in Hull and provides NHS and private treatment to adults and children.

Car parking spaces are available near the practice. Due to both surgeries being located on the first floor, wheelchair users are directed to a local practice with step free access to ground floor facilities.

The dental team includes two dentists, four dental nurses, a dual site practice manager and a receptionist. The practice has two treatment rooms.

The practice is owned by an individual. 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.

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

The practice is open:

Monday – Friday 9am – 5pm.

Our key findings were:

• The practice was 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.
• 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 effective leadership. 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 carried out this announced inspection on 31 May 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 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

Bilton Dental Practice is located in Hull and provides NHS and private treatment to adults and children.

Car parking spaces are available near the practice. Due to both surgeries being located on the first floor wheelchair users are directed to a local practice with step free access to ground floor facilities.

The dental team includes two dentists, four dental nurses, a dual site practice manager and a receptionist. The practice has two treatment rooms.

The practice is owned by an individual. 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 17 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, two dental nurses, a receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday – Friday 9am – 5pm.

Our key findings were:

• The practice was cluttered and required some building work.
• The practice had infection control procedures which reflected published guidance. We found the flow could be improved upon in the surgeries to clarify clean and dirty zoned areas.
• Staff knew how to deal with emergencies. Some emergency equipment required replacement.
• The practice had systems to help them manage risk.
• The practice had safeguarding processes and staff knew their responsibilities for safeguarding adults and children. We found this was not always acted upon.
• The practice had thorough staff recruitment procedures.
• Improvements could be made to bring care and treatment of patients 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 did not have effective leadership.
• The practice dealt with complaints positively and efficiently.

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

• Ensure the process for checking medical emergency equipment to manage medical emergencies takes into account guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Ensure the staff are aware of their responsibilities under the practice's safeguarding policies with regard to sharing information of concern.

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 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 system for recording, investigating and reviewing incidents or significant events with a view to preventing further occurrences and ensuring that improvements are made as a result.
• Review the practice’s protocols and procedures for promoting the maintenance of good oral health taking into account guidelines issued by the Department of Health publication ‘Delivering better oral health: an evidence-based toolkit for prevention’
• Review the practice's current audit protocols to ensure audits of key aspects of service delivery are undertaken at regular intervals and where applicable learning points are documented and shared with all relevant staff.
• Review the practice responsibilities to respond to the needs of patients with disability and the requirements of the Equality Act 2010.
• Review dental care records to ensure they are complete and accurate including treatment provided, decisions made, risks and benefits.

Bilton Dental Practice was a small practice with two dentists and two dental nurses. The practice manager was also responsible for another surgery in Hull. We were able to speak with the dentists and the two dental nurses during our visit and we also spoke with three patients.

The patients thought the service provided was excellent, one person said "I moved here from another place where I was unhappy and they have been very thorough here”. Another person said "The service and treatment has always been excellent" The patients all said they were treated in a manner that respected their human rights and diversity in a fair and equal way. All of the patients said that the service was relaxed, treatments were explained and the staff were friendly and helpful.

We saw that the dentists and dental nurses followed their infection control policy and wore personal protective equipment for all consultations. We saw a cleaning rota for the surgery and it was found to be clean and well maintained.

The dental nurses said they worked together well as team and managed to discuss any issues that may have been raised during the working day. They said that they felt they were supported by the dentist and the practice manager and accessed training as they need to.