We carried out an announced follow up comprehensive inspection on 16 February 2017 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

We had undertaken an unannounced focused inspection of this service on the 2 December 2016 as part of our regulatory functions where breaches of legal requirements were found.

After the focused inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to each of the breaches.

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

We revisited the Bolton Road Dental Centre as part of this review and checked whether they had followed their action plan and to confirm that they now met the legal requirements regarding the practice's recruitment policy and procedures, infection control procedures and protocols, COSHH risk assessments, recommendations from the legionella risk assessment and review emergency equipment. We checked these areas as part of this comprehensive inspection and found they had been partially resolved.

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 providing well-led care in accordance with the relevant regulations

Background

Bolton Road Dental Centre provides NHS and private treatment for both adults and children. The practice is situated in a converted commercial property. There are four dental treatment rooms and a separate decontamination room. Dental care was provided on two floors and had a reception and waiting area on the ground floor and an additional waiting area on the first floor.

The practice is open from 9am to 5.30pm Monday to Friday.

The practice has four dentists and six dental nurses, two of which are trainees. The clinical team is supported by a practice manager and reception staff.

The practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• The premises were visibly clean and tidy.
• Staff had received safeguarding training, but were unfamiliar with the process to follow to raise concerns.
• There were sufficient numbers of suitably qualified, skilled staff to meet the needs of patients.
• Staff had been trained to deal with medical emergencies, emergency medicines and equipment were available.
• Patients’ needs were assessed, and care and treatment were delivered, in accordance with current legislation, standards, and guidance.
• Patients received information about their care, proposed treatment, costs, benefits, and risks and were involved in making decisions about it.
• Staff were supported to deliver effective care, and opportunities for training and learning were available.
• Patients were treated with kindness, dignity, and respect.
• The appointment system met the needs of patients, and emergency appointments were available.
• Services were planned and delivered to meet the needs of patients, and reasonable adjustments were made to enable patients to receive their care and treatment.
• The practice gathered the views of patients and took their views into account.
• Staff told us they were supported, felt involved, and worked as a team.

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

• Review the practice’s sharps handling procedures and protocols are in compliance with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).
• Review the practice’s system for the 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 for the use of rubber dam for root canal treatment giving due regard to guidelines issued by the British Endodontic Society.
• Review the practice’s safeguarding policy and ensure all staff are aware of their responsibilities.
• Review its responsibilities as regards to the Control of Substance Hazardous to Health (COSHH) Regulations 2002 and, ensure all documentation is up to date and staff understand how to minimise risks associated with the use of and handling of these substances.
• Review the learning and development needs of individual staff members and have an effective process established for the on-going assessment and supervision of all staff.
• Review its audit protocols to document learning points that are shared with all relevant staff and ensure that the resulting improvements can be demonstrated as part of the audit process.

We carried out an unannounced responsive inspection on 2 December 2016 to ensure the practice was providing safe care in respect of the regulations; we did not inspect other aspects of the service.

Our findings were:

Are services safe?

We found that this practice was not providing safe care in accordance with the relevant regulations.

Background

Bolton Road Dental Centre provides NHS and private treatment for both adults and children. The practice is situated in a converted commercial property. There are four dental treatment rooms and a separate decontamination room for cleaning, sterilising and packing dental instruments. Dental care was provided on two floors and had a reception and waiting area on the ground floor and an additional waiting area on the first floor.

The practice is open from 9am to 5.30pm Monday to Friday.

The practice has four dentists and six dental nurses, two of which are trainees. The clinical team is supported by a practice manager and reception staff.

The practice manager is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

Our key findings were:

• The practice had access to an automated external defibrillator. The low battery indicator was visible and staff were unsure whether a new battery had been ordered.
• The practice's recruitment policy and procedures and recruitment arrangements were not in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The necessary employment checks were not in place for all staff and the required specified information in respect of persons employed by the practice was not held.
• Local anaesthetic cartridges and other dental materials were stored in an unlocked cupboard which was accessible to patients. The cleaning equipment was also stored here and was not segregated or stored correctly.
• We observed that prescription pads were not stored securely; these were left on the work surface in two unlocked and unattended surgeries. Computers were left on when the surgery was unattended as were X-ray machines.
• The cluster manager could not provide assurance that all staff were protected against hepatitis B.
• A Legionella risk assessment had been carried out in January 2015. We found the recommendations in the report had not been acted upon and water temperature testing was not being undertaken.
• We observed that the workflow in the decontamination room and surgeries was not well-defined and clean and dirty zones were not clearly identified.
• We were told returned laboratory work was not disinfected before placement.
• We looked at the practice risk assessments including safe use of sharps, fire, clinical waste, COSHH and manual handling and found these were incomplete and contained minimal information.
• Practice policies and procedures were available to staff but these were due for review in January 2016. We found some policies referred to old guidelines.

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

• Ensure the practice's recruitment policy and procedures are suitable and the recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to ensure necessary employment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.
• Ensure the practice’s infection control procedures and protocols have regard to guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Ensure COSHH risk assessments for all dental materials used within the practice are implemented.
• Ensure the current legionella risk assessment implements the required actions including the monitoring and recording of water temperatures, giving due regard to the guidelines issued by the Department of Health - Health Technical Memorandum 01-05:
• Ensure the checks that are in place to review the emergency equipment, including the AED are more effective to ensure the recording of any equipment that is missing or out of date to facilitate it being replaced in a timely manner.

You can see full details of the regulations not being met at the end of this report.

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

• Review availability of medicines and equipment to manage medical emergencies giving due regard to guidelines issued by the Resuscitation Council (UK), and the General Dental Council (GDC) standards for the dental team.
• Review the security of prescription pads in the practice and ensure there are systems in place to monitor and track their use.
• Review the storage of medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.
• Review the practice policy and process for decontamination in primary care dental practices and The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance
• Review the protocols and procedures for use of X-ray equipment giving due regard to guidance notes on the Safe use of X-ray Equipment.
• Review the protocols and procedures to ensure staff are up to date with their mandatory training and their Continuing Professional Development.
• Review the practice confidentiality policy with regard to the use of CCTV cameras within the dental practice and ensure all information, assessments and signage are implemented as per the Information Commissioning Office (ICO) recommendations.

We were shown the results of the last patient survey completed this year. Comments included:

“The staff are always helpful”.

“You can always get an appointment”.

“The care and attention is very good”.

“It’s clean but needs painting”.

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Patients told us:

“They provide a good service”.

“The staff are kind and considerate”.

“You are given time to decide whether to go ahead with any treatments”.

“I am always provided with an apron and glasses for protection”.