We carried out a comprehensive inspection at this practice on 15 November 2016 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was providing safe, effective, caring and responsive care in accordance with relevant regulations.

We judged that 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.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection on 28 June 2017 to check that they had followed their plan and to confirm that 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 Cathedral View Dental Practice on our website at www.cqc.org.uk.

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?

Are services well-led?

We found that the provider had taken effective action to deal with the shortfalls we found at our inspection on 15 November 2016. We found that this practice was providing well-led care in accordance with regulation 17.

Background

Cathedral view Dental Practice is a dental practice providing private care for adults and private and NHS care for children. Where private treatment is provided some is under a fee per item basis and some under a dental insurance plan. The practice is situated in a converted residential property with all patient facilities on the ground floor.

The practice has three dental treatment rooms. There is also a reception and waiting area and other rooms used by the practice for office facilities and storage. The practice is open from 8.30am to 5pm from Monday to Friday. The practice closes for lunch between 1pm to 2pm.

The practice has three part-time dentists who are able to provide general dental services including endodontic treatment and some cosmetic dentistry. They are supported by two dental nurses, a trainee dental nurse, three part time dental hygienists, a practice manager and receptionist.

The practice owner 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.

We carried out an announced comprehensive inspection on 15 November 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

Cathedral View Dental Practice is a dental practice providing private care for adults and private and NHS care for children. Where private treatment is provided some is under a fee per item basis and some under a dental insurance plan. The practice is situated in a converted residential property with all patient facilities on the ground floor.

The practice has three dental treatment rooms. There is also a reception and waiting area and other rooms used by the practice for office facilities and storage. The practice is open from 8.30am to 5.00pm from Monday to Friday. The practice closes for lunch from 1.00pm to 2.00pm.

The practice has three part-time dentists who are able to provide general dental services including endodontic (root canal) treatment and some cosmetic dentistry. They are supported by two dental nurses, a trainee dental nurse, three part time dental hygienists, a practice manager and receptionist.

The practice owner 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.

Before the inspection we sent Care Quality Commission comment cards to the practice for patients to complete to tell us about their experience. We also spoke with patients on the day of our inspection. We received feedback from a total of seven patients. The majority of feedback was positive with patients commenting favourably on the quality of care and service they received, the professional and helpful nature of staff and the cleanliness of the practice. However some patients also commented negatively on appointments not running to time and availability of appointments.

Our key findings were:

• Staff reported incidents which were investigated, discussed and learning implemented to improve safety. However we found the system was not always effective as not all incidents had been reported.

• The practice was visibly clean and well maintained but we found that not all infection control procedures were in line with the requirements of the ‘Health Technical Memorandum 01-05 (HTM 01-05): Decontamination in primary care dental practices’ published by the Department of Health. For example ultrasonic baths were in use which had not been validated. We were told following our inspection that these had been decommissioned.

• The practice had medicines and equipment for use in a medical emergency which were in accordance with national guidelines with the exception that glucagon was not stored in a temperature monitored fridge. The medicines were not stored securely. We were advised following our inspection that these issues would be addressed.

• Staff had received training appropriate to their roles and were supported in their continued professional development (CPD).

• Patients commented that they were pleased with the care they received and that staff were helpful, kind and courteous. However some patients commented that they were not always able to get appointments in a timely way.

• The practice had suitable facilities and was equipped to treat patients and meet their needs.

• Governance arrangements were in place for the smooth running of the service. However we found that protocols were not always followed and some policies required updating. Although risks had been assessed we found that the fire risk assessment was not comprehensive; for example it had not identified the requirement for an Electrical Installation Condition Report and no consideration had been given to the evacuation of patients with disabilities.

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

Ensure systems and processes are operated effectively to assess and monitor the service and risks in accordance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. For example, this includes the management of patient safety alerts; significant event reporting, infection control, fire safety arrangements and storage of medicines.

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

• Review the practice’s audit protocols of radiography to ensure they are practitioner specific to help improve the quality of service. The practice should also check all audits have documented learning points and the resulting improvements can be demonstrated.

People told us that they felt respected by this practice and had been involved in decisions about their dental treatment and care. One person told us that, “The dentist is excellent and always tells me about any treatment that l need.” This meant that people’s privacy, dignity and independence were respected.

We reviewed seven people's dental treatment records. These were completed appropriately and showed us that people's dental care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare.

We saw that systems and processes were in place to decontaminate the re-usable equipment used by the practice in line with the essential standards guidance. This showed us that people were cared for in a clean and hygienic environment.

Staff had a good understanding of safeguarding and were confident that they would recognise and know what action to take if they observed any potential abuse. This showed us that the provider had taken steps to identify the possibility of abuse and prevent abuse from happening.

Those individual treatment records seen demonstrated that people's dental requirements were reviewed upon each visit to the service and discussed with the person using the surgery. This showed us that the provider had an effective system to assess and monitor the quality of the professional services being provided.