This was an announced visit to follow up two areas of non-compliance found during our inspection in July 2014. Following the previous inspection we took enforcement action against Catherine Court Dentistry to protect the health, safety and welfare of patients using this service.

Previously we had found concerns with how the provider ensured staff were recruited appropriately to assure staff were suitable for the roles for which they were employed. We also identified areas of improvement required to the quality and monitoring practices at Catherine Court Dentistry.

At this inspection we spoke to the provider, three staff and looked at practice records. We found there were improvements to how the practice managed the staff recruitment process. Staff recruitment files were orderly with numbered sections to enable documentation to be easily found. Sections included documents related to the interview process, security checks and professional requirements for example, registration status and professional indemnity.

We found the provider had made improvements to how they monitored and evaluated the service they provided. The provider had completed essential audits of practice, improved the safety of the practice by following through on recommendations of a fire inspection and regularly monitored the emergency and infection control procedures.

This was an announced visit to follow up two areas of non-compliance found during our inspection in July 2013. Previously we had found concerns with how the provider managed control of infection practices and how they ensured staff were recruited appropriately to ensure they suitable for the roles for which they were employed. We also identified areas of improvement of the overall practices at Catherine Court Dentistry.

Following the previous inspection we required the provider to submit an action plan of how they intended to ensure the service was compliant within the areas of control of infection and recruitment. The provider did not submit this information to the Care Quality Commission. We returned to check they had taken steps to protect the patients who used the service.

We gave the provider 48 hours’ notice of our intention to inspect the dental practice. We also made contact via email and telephone before the visit to request that information be made available for inspection during our visit. The registered manager/ nominated individual was not present during the inspection. We informed staff present at the end of the inspection of the opportunity to submit within 48 hours any other information to demonstrate compliance. We did not speak to patients during this inspection.

We found there were improvements of how the practice managed infection control which meant patients and staff were protected by the infection control measures as implemented at Catherine Court Dentistry. We raised some areas for further improvement during our visit for which the lead dental nurse provided subsequent evidence of implementation.

We were not provided with any documentary evidence of there being a robust recruitment process in place therefore patients could not be assured they were cared for and treated by appropriately skilled and experienced staff.

We also looked at some aspects of the providers overall quality assurance processes because we observed during our inspection visit gaps in the implementation of health and safety guidance and there was no information how this was monitored. In the interest of public safety, we made a referral to the local fire service about our concerns over the lack of signage for fire exits and the storage of oxygen at the practice.

We spoke with both adults and children at the practice. All those we spoke with said they were happy with the care and treatment they received. One person said of the care: "it's excellent. I was recommended to come here and I'm glad I did." One child we spoke with said they had no anxiety about visiting the dentist. They said they had "really good teeth" and their dentist told them about looking after them. An adult patient we met who was anxious about treatment said their dentist had "really put me at ease."

People said they could usually get appointments to suit them, including for urgent treatment. There were arrangements for people to get help when the practice was closed. The dentists talked to people about their general health and made sure the practice had all the relevant information before treating someone. All staff we met knew how to act in the event of a medical emergency and the practice had the required emergency equipment.

The dentists took time to explain the risks and benefits of any treatment. People said they made up their own mind about how to progress and could withdraw consent at any time.

The practice and equipment was generally clean, but a number of the requirements of the code of practice for the prevention and control of infection for dental practices were not in place. This related mostly to the layout of the decontamination facilities, the audit of the process, personal protection equipment available to, or worn by staff when cleaning dental equipment, some fixtures and fittings, and the general cleaning programme.

We found some staff had not had external checks prior to taking up their position.