We undertook a focused inspection of Brownhills dental practice on 5 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 Brownhills dental practice on 5 December 2017 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 Brownhills 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 5 December 2017.

Background

Brownhills dental practice is in Brownhills, Walsall and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. A free car park which includes spaces for patients with disabled badges is available near the practice.

The dental team includes two dentists (including the principal dentist), four dental nurses, including one trainee dental nurse and two receptionists, one of whom is the assistant manager. The practice has two treatment rooms.

The practice is owned by an organisation 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. The registered manager at Brownhills dental practice is the principal dentist.

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

The practice is open: Monday to Thursday 9.30am to 5pm, Friday 8.30am to 4pm and Saturday by appointment only 9am to 12mid-day.

Our key findings were:

• The practice was giving due regard to the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

• The practice had systems in place to ensure that emergency medicines and equipment were available and within their expiry date.

• The practice were giving due regard to the guidelines issued by the Department of Health in the Health Technical Memorandum 01-05: Decontamination in primary care dental practices.

• The practice had undertaken a review of stocks of medicines and equipment and implemented a system for identifying, disposing and replenishing of out-of-date stock.

• The provider had reviewed the practice’s audit protocols to ensure audits of various aspects of the service were undertaken at regular intervals and where applicable learning points were documented and shared with all relevant staff.

• The practice had systems in place to track and monitor the safe and secure use of NHS prescription pads.
• The practice were unable to demonstrate that they had obtained information about any physical or mental health conditions relevant to a person’s capability, after reasonable adjustments are made, to properly carry out tasks they are expected to perform as staff recruitment files were not available at the practice. We were told that this information would be sent to us following this inspection. We did not receive this information by the deadline date given.
• The practice had suitable arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare Products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.

• The practice had protocols for the use of rubber dam for root canal treatment taking into account guidelines issued by the British Endodontic Society.

• The practice had protocols in place for completion of dental care records which took into account the guidance provided by the Faculty of General Dental Practice.

• The practice had reviewed staff awareness of the requirements of the Mental Capacity Act 2005 and Gillick competency, training had been provided to ensure that all staff are aware of their responsibilities under the Act as it relates to their role.
• The practice had purchased a hearing loop and put signage in place informing patients that this equipment was available for use.

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

Review the practice's recruitment procedures to ensure that appropriate checks are completed prior to new staff commencing employment at the practice.