We carried out a focused inspection of Bupa – Summer Road, Erdington on 5 March 2018.

We carried out the inspection to follow up concerns we originally identified during a comprehensive inspection at this practice on 17 October 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 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 Bupa – Summer Road, Erdington on our website www.cqc.org.uk.

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

Our findings were:

• We found this practice was providing well-led care in accordance with the relevant regulations. The provider had made adequate improvements to put right the shortfalls and deal with the regulatory breach we found at our inspection on 17 October 2017.
• Since the previous inspection a new registered manager had been appointed at the practice. They had experience as a registered manager in one of the sister practices and were transferred to this practice.

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

• Review the practice’s system for recording, investigating and reviewing incidents with a view to preventing further occurrences and ensuring that improvements are made as a result.

We carried out this announced inspection on 17 October 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 that we were inspecting the practice. They did not provide any information for us to take into account.

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

Oasis Dental Care - Erdington is located in Birmingham and provides NHS and private treatment to patients of all ages.

The treatment rooms are located on the first floor so access is limited for people who use wheelchairs and pushchairs. Car parking spaces are available near the practice.

The dental team includes five dentists, four dental nurses (one of whom is a trainee), one dental hygienist and two receptionists. The team is supported by a practice manager. Additional dental nursing staff are also transferred to this practice from their sister practice when required. The practice has three treatment rooms.

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. The registered manager at Oasis Dental Care - Erdington was the practice manager. At the time of the inspection visit, our records showed the practice had registered two persons as their registered managers at Oasis Dental Care – Erdington. We discussed this with the practice manager and they informed us they were the only registered manager as the other registered manager had left the company. They assured us they would update their registration details.

On the day of inspection we collected one CQC comment card filled in by a patient and spoke with four other patients. This information gave us a positive view of the practice.

During the inspection we spoke with two dentists, three dental nurses, one 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 between 8am and 7pm on Mondays and Tuesdays. It is open between 9am and 7pm on Wednesdays and between 9am and 5pm on Thursdays and Fridays.

Our key findings were:

• The practice was visibly clean but some improvements were required with respect to the flooring, work surfaces and walls in clinical areas. One item of equipment was soiled.
• The practice had infection control procedures which reflected published guidance but improvements were required relating to audits, instrument storage and disinfection of laboratory work.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had limited systems to help them manage risk.
• The practice had suitable safeguarding processes and staff knew their responsibilities for safeguarding adults and children. Some of the policies were obsolete and required updating.
• The practice had limited staff recruitment procedures. There was no written policy and some essential documentation was not available in the staff recruitment files.
• 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, 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 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 its responsibilities to the needs of people with a disability, including those with hearing difficulties and the requirements of the Equality Act 2010.

During our last inspection in September 2013 we found that the system for recruiting staff was not robust. This visit to the practice was announced to ensure we had the opportunity to speak to the practice manager and review the recruitment process.

We looked at the recruitment policy, spoke with the practice manager and reviewed the personnel file of a newly appointed dentist. We found that the required documentation was in place. This included references and employment history.

During this inspection we spoke with the manager, two dentists, two dental nurses and two other staff members. We observed three treatments and spoke with 13 people who use the service.

We found that people had the information they needed to help them make choices about their treatment. One person told us, "I have been given good advice."

People told us that they had no concerns about the care and treatment that they received. One person told us, "My child was very nervous but they explained everything and took their time with the treatment. I am happy with them."

We found that people received care and treatment in a visibly clean environment so that the risk of infections were reduced. One person told us, "It always looks clean to me."

We found that the recruitment process was not robust. Effective recruitment procedures were not in place to ensure suitable people were employed.

We saw that the provider had systems in place to monitor the quality of the service that people received so that areas for further improvement could be identified. People we spoke with told us that they had no concerns about the quality of the service.