We carried out an announced inspection of this practice on 11 February 2016 where breaches of legal requirements were found. After the inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to well led care and treatment.

We undertook this focused inspection to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cadis Dental Practice on our website at www.cqc.org.uk

Our findings were:

Are services well-led?

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

Background

The practice offered private dental treatment to patients of all ages. This was a single handed principal dentist supported by a dental nurse in addition to reception staff.

The principal dentist is the registered provider for the practice. 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.

The practice has one treatment room, reception/waiting area and decontamination room. The practice is open one day per week 9.00am until 5.00pm.

Our key findings were:

• The practice is now compliant with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000 including conducting regular quality audits of the X-rays.
• The practice is now compliant with Decontamination processes in accordance with HTM 01:05 guidelines: Decontamination in primary care dental practices or The Health and Social Care Act 2008:‘Code of Practice about the prevention and control of infections and related guidance.
• The registered provider had ensured that infection control, clinical and non-clinical record keeping were now in place.
• Emergency medicines were now in date and easily accessible and an automated external defibrillator (AED) had also been purchased to be easily accessible in an emergency.

We carried out an announced comprehensive inspection on 11 February 2016 to ask the practice the following key questions; Are services safe, effective, caring, responsive and well-led?

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

The practice offered private dental treatment to patients of all ages. This was a single handed principal dentist supported by a dental nurse in addition to reception staff.

The principal dentist is the registered provider for the practice. 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.

The practice has one treatment room, reception/waiting area and decontamination room. The practice is open five days per week 9.00am until 5.00pm.

Unfortunately the principal dentist was unable to attend on the day of our visit and all patient appointments were cancelled. We did however speak with the principal dentist after the inspection visit.

We did not receive any returned comment cards that had been left for patients to complete, prior to our visit. However we were able to speak with two patients on the day of our inspection. Feedback from patients was positive about the care they received from the practice. They commented staff were caring and respectful and that they had confidence in the dental services provided. Patients told us the dentist was good at putting them at ease, building children’s confidence in dental procedures and involving them in their treatment.

Our key findings were:

• Staff had received safeguarding training, knew how to recognise signs of abuse and how to report it.
• Staff had been trained to manage medical emergencies.
• Patients commented they felt involved in their treatment and that it was fully explained to them.
• Patients were able to make routine and emergency appointments when needed. There were clear instructions for patients regarding out of hours care.
• Patients told us staff were kind, caring and competent.
• Patient care and treatment was planned and delivered in line with evidence based guidelines and current regulations.
• Patients received clear explanations about their proposed treatment, costs, benefits and risks and were involved in making decisions about it.
• Patients told us they were treated with dignity and respect and their confidentiality was maintained.

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

• Ensure audits of radiography, dental care records and infection control are undertaken at regular intervals to help improve the safety and quality of the service. The practice must also ensure all audits have documented learning points and the resulting improvements can be demonstrated.
• Ensure that the practice is in compliance with its legal obligations under Ionising Radiation Regulations (IRR) 99 and Ionising Radiation (Medical Exposure) Regulation (IRMER) 2000.
• Ensure the procedure for rinsing and cleaning used dental instruments is robust and meets guidelines issued by the Department of Health - Health Technical Memorandum 01-05: Decontamination in primary care dental practices.
• Ensure that staff follow cleaning guidelines detailed in The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance.
• Ensure the right medical emergency equipment is in place and risk assess how they would manage a medical emergency in the absence of an automated external defibrillator (AED).

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 the system for stocking Personal Protective Equipment (PPE) to ensure it is continually available for staff.
• Review how staff are suitably supported in undertaking their duties, for example through performance appraisals
• Review the current legionella risk assessment and implement 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: 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.